β-Lactam Monotherapy vs β-Lactam–Macrolide Combination Treatment in Moderately Severe Community-Acquired Pneumonia: A Randomized Noninferiority Trial

This study found beta-lactam monotherapy (cefuroxime or co-amoxiclav) was not non-inferior to beta-lactam plus macrolide (clarithromycin IV or oral) in terms of clinical stability (not reached in 41.2% v 33.6%, respectively) in the empirical treatment of moderately severe CAP.

Guidelines on the management of CAP from the British Thoracic Society (BTS) currently recommend dual empirical antibiotic treatment for those with moderate to severe CAP; oral monotherapy with amoxicillin is preferred for those with low severity CAP. For more details please see the guideline at the link below. 

 

The authors of an accompanying commentary article believe this study “pushes the pendulum further in favour of antibiotic therapy covering atypical and typical bacterial pathogens for patients hospitalized for CAP”. They call for further, larger trials powered to detect differences in important clinical outcomes, such as short-term mortality and antibiotic harms, and to compare fluoroquinolone only, beta-lactam and macrolide, and beta-lactam only therapies, to assess the role of other commonly recommended agents with atypical coverage.