Clarithromycin adjunct treatment leads to substantial financial savings in community-acquired pneumonia: sub-analysis of the ACCESS trial

• Published in: Journal of global antimicrobial resistance. 2024-12, Vol.39, p.5-5
• Main Authors: Rapti, Vasiliki, Tasouli, Elisavet, Kotsaki, Antigone, Niotis, Georgios, Chatzopoulos, Marios, Christaki, Eirini, Bourboulis, Evangelos J. Giamarellos, Poulakou, Garyphalia
• Format: Article
• Language: English
• Subjects: clarithromycin; cost; pneumonia
• ISSN: 2213-7165
• DOI: 10.1016/j.jgar.2024.10.014

In the ACCESS randomized controlled trial addition of oral clarithromycin 500mg two times daily for seven days to standard-of-care (SoC) antibiotics provided substantial clinical benefit in adult patients hospitalized for community-acquired pneumonia (CAP) including early clinical responses, decreased progression to organ dysfunction and a reduction in the incidence of secondary sepsis (Giamarellos-Bourboulis EJ, et al. Lancet Resp Med 2024; 12: 294-304). We hypothesized that the above-described clinical benefits of clarithromycin may lead to early reduction of the cost of management of CAP. The daily cost of hospital/ICU stay, of antibiotics and all adjunctive medication (including placebo/clarithromycin) were summed for the first 8 days of the study. The cumulative cost for the first 8 days since start of the study drug is presented in Figure 1. By day 8, the mean total cost per patient in the SoC plus placebo group was €1332.0 compared with €1085.20 in the SoC plus clarithromycin group (p: 0.018), a saving of approximately 18% during the first week of treatment. The addition of clarithromycin to SoC antibiotics substantially decreased the cost of early-stage management of hospitalized patients with CAP in the ACCESS trial. The observed 16.7% improvement on live hospital discharge to day 90 with clarithromycin may be expected to contribute to additional cost savings beyond Day 8. Further analysis of the impact of clarithromycin on the overall 90-day cost will follow.