An open, randomized, comparative study of clarithromycin and erythromycin in the treatment of children with community-acquired pneumonia
Ping-Ing Lee, Mei-Hwan Wu, Li-Min Huang, Jong-Min Chen, Chin-Yun Lee
Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Received: May 3, 2006 Revised: September 4, 2006 Accepted: October 9, 2006
Background and purpose:
This study aimed to evaluate the efficacy and safety of clarithromycin and erythromycin in the treatment of community-acquired pneumonia in children.
Children with community-acquired pneumonia were randomly assigned to receive 10-day regimens of either clarithromycin 15 mg/kg/day, twice a day, or erythromycin 30-50 mg/kg/day, four times daily.
A total of 97 children entered this study, including 26 with Mycoplasma pneumoniae infection, 15 with Chlamydia pneumoniae infection, and 6 with mixed mycoplasma and chlamydia infections. Fifty and 47 children received clarithromycin and erythromycin treatment, respectively. Three children withdrew from the study because the identified pathogens were resistant to the study drugs. All 47 children with mycoplasma or chlamydia infection were cured clinically. Delayed defervescence, defined as a fever lasting for more than 72 h after treatment, was observed in 4 of 22 clarithromycin-treated children (18%) and in 3 of 15 erythromycin-treated children (20%) [p>0.05]. Gastrointestinal side effects, including vomiting, abdominal pain and diarrhea, were observed in 3 of 50 children (6%) receiving clarithromycin and in 11 of 49 children (22%) receiving erythromycin (p=0.039). Excluding children with abnormal pretreatment liver function, abnormal liver function after treatment was observed in only one child, treated with erythromycin. Post-treatment eosinophil and platelet counts were significantly elevated after treatment in both groups.
Clarithromycin showed efficacy equivalent to erythromycin for the treatment of mycoplasma or chlamydia pneumonia in children. However, the tolerability of clarithromycin was superior to that of erythromycin.
Chlamydia pneumoniae; Community-acquired infections; Macrolides; Mycoplasma pneumoniae; Pneumonia; Randomized controlled trial
J Microbiol Immunol Infect. 2008;41:54-61.