MYCOPLASMA-PNEUMONIAE AND CHLAMYDIA-PNEUMONIAE IN PEDIATRIC COMMUNITY-ACQUIRED PNEUMONIA - COMPARATIVE EFFICACY AND SAFETY OF CLARITHROMYCIN VS ERYTHROMYCIN ETHYLSUCCINATE

We evaluated 260 previously healthy children ages 3 through 12 years who had clinical signs and symptoms of pneumonia, radiographically confirmed, Patients were randomized 1:1 to a 10-day course of either clarithromycin suspension 15 mg/kg/day divided twice a day or erythromycin suspension 40 mg/kg/day divided twice a day or three times a day, Evidence of infection with Chlamydia pneumoniae was detected in 28% (74) of patients: 13% (34) by nasopharyngeal culture and 18% (48) by serology with the microimmunofluorescence assay, Evidence of infection with Mycoplasma pneumoniae was detected in 27% (69) of patients: 20% (53) by nasopharyngeal culture or polymerase chain reaction and 17% (44) by serology with the use of enzyme-linked immunosorbent assay, Serologic confirmation of infection was observed in 23% (8) and 53% (28) of patients with bacteriologically detected C. pneumoniae and M. pneumoniae, respectively. Treatment with clarithromycin vs. erythromycin, respectively, yielded the following outcomes: clinical success 98% (121 of 124) vs, 95% (105 of 110); radiologic success 98% (109 of 111) vs, 94% (92 of 110); and eradication by pathogen, C. pneumoniae 79% (15 of 19) vs, 86% (12 of 14) and M. pneumoniae 100% (9 of 9) vs, 100% (4 of 4). Adverse events were primarily gastrointestinal, occurring in almost one-fourth of patients in both groups, and were mild to moderate in severity, Clarithromycin and erythromycin were similarly effective and safe for the treatment of radiographically proved, community-acquired pneumonia in children older than 2 years old, Because C. pneumoniae or M. pneumoniae was detected in nearly one-half of these patients, macrolides may be the preferred antibiotic choice for uncomplicated pneumonia in nontoxic children ages 3 through 8 years.