Systematic review and meta-analysis of the safety of erythromycin compared to clarithromycin in adults and adolescents with pneumonia

Macrolides are recommended for the treatment of community-acquired pneumonia (CAP). It is debatable whether erythromycin is associated with more adverse drug reactions (ADRs) compared to clarithromycin, and both are recommended in clinical practice guidelines. This meta-analysis aim is to compare AD...

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Published in:Journal of chemotherapy (Florence) 2020-01, Vol.32 (1), p.1-6
Main Authors: Eljaaly, Khalid, Botaish, Ahmed, Bahobail, Fawaz, Almehmadi, Mohamed, Assabban, Ziyad, Thabit, Abrar K., Alraddadi, Basem, Aljabri, Ahmed, Alqahtani, Nasser, Aseeri, Mohammed A., Hashim, Almoutaz, Torres, Antoni
Format: Article
Language:English
Subjects:
Adolescent
Adult
Anti-Bacterial Agents - therapeutic use
Clarithromycin
Clarithromycin - therapeutic use
Community-Acquired Infections - drug therapy
Erythromycin
Erythromycin - therapeutic use
Female
Gastrointestinal
Humans
Male
Nausea
Pneumonia
Pneumonia, Bacterial - drug therapy
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Summary:Macrolides are recommended for the treatment of community-acquired pneumonia (CAP). It is debatable whether erythromycin is associated with more adverse drug reactions (ADRs) compared to clarithromycin, and both are recommended in clinical practice guidelines. This meta-analysis aim is to compare ADRs in CAP patients treated with erythromycin versus clarithromycin. Two investigators independently searched PubMed, EMBASE and Cochrane Library databases through Feb 07, 2019. Randomized-controlled trials (RCTs) comparing ADRs of monotherapy with erythromycin versus with clarithromycin in adults or adolescents with CAP were included. We estimated risk ratios (RRs) with 95% confidence intervals (CIs) using random-effects models and evaluated heterogeneity (I 2 ). Bias risk was assessed using the Cochrane risk of bias tool for RCTs. Five RCTs (total of 693 patients) were included. A significantly higher discontinuation rate due to ADRs was found with erythromycin compared with clarithromycin (RR, 4.347; 95% CI, 2.506-7.539; p 
ISSN:1120-009X
1973-9478
DOI:10.1080/1120009X.2019.1680116