Ceftriaxone versus ceftriaxone plus a macrolide for community-acquired pneumonia in hospitalized patients with HIV/AIDS: a randomized controlled trial

Author(s)

Figueiredo-Mello, C. ^{[1, 2]} ; Naucler, P. ^{[3, 4]} ; Negra, M. D. ^[5] ; Levin, A. S. ^[1]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Dept Infect Dis, Sao Paulo - Brazil

^[2] Inst Infectol Emilio Ribas, Dept Educ & Res, Sao Paulo - Brazil

^[3] Karolinska Inst, Infect Dis Unit, Dept Med Solna, Stockholm - Sweden

^[4] Karolinska Univ Hosp, Dept Infect Dis, Stockholm - Sweden

^[5] Inst Infectol Emilio Ribas, Sao Paulo - Brazil

• Document type: Journal article
• Source: Clinical Microbiology and Infection; v. 24, n. 2, p. 146-151, FEB 2018.
• Web of Science Citations: 5

Abstract

Objectives: To evaluate if treatment with ceftriaxone and a macrolide, improved patient outcome when compared with monotherapy with ceftriaxone, in hospitalized patients with human immunodeficiency virus/acquired immunodeficient syndrome (HIV/AIDS) with community-acquired pneumonia (CAP). Methods: Adult patients with HIV hospitalized due to suspected CAP were randomized to receive one of two regimens, ceftriaxone plus macrolide or ceftriaxone plus placebo, at a 1:1 proportion (Brazilian Clinical Trials Registry: RBR-8wtq2b). The primary outcome was in-hospital mortality and the secondary outcomes were mortality within 14 days, need for vasoactive drugs, need for mechanical ventilation, time to clinical stability and length of hospitalization. Results: A total of 227 patients were randomized, two were excluded after randomization; 225 patients were analysed (112 receiving ceftriaxone plus placebo and 113 receiving ceftriaxone plus macrolide). The frequency of the primary outcome, in-hospital mortality, was not statistically different between the regimens: 12/112 (11%) patients who received ceftriaxone plus placebo and 17/113 (15%) who received ceftriaxone plus macrolide died during hospitalization (hazard ratio 1.22, 95% CI 0.57-2.59). We did not find differences between the regimens for any of the secondary outcomes, including mortality within 14 days, which occurred in 5/112 (4%) patients with ceftriaxone plus placebo and in 12/113 (11%) patients with ceftriaxone plus macrolide (relative risk 2.38, 95% CI 0.87-6.53). Conclusions: Among hospitalized patients with HIV/AIDS with CAP, treatment with ceftriaxone and a macrolide did not improve patient outcomes, when compared with ceftriaxone monotherapy. (c) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. (AU)

• FAPESP's process: 12/03834-7 - Prospective study on clinical features and etiologic agents of community-acquired pneumonia in HIV-infected patients
• Grantee: Anna Sara Shafferman Levin
• Support Opportunities: Regular Research Grants