The role of macrolides in severe community-acquired pneumonia and the potential impact of macrolide-resistant Mycoplamsa pneumoniae.

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES
Current Opinion in Infectious Diseases Pub Date : 2025-04-01 Epub Date: 2024-12-18 DOI:10.1097/QCO.0000000000001087
Nikos Antonakos, Evangelos J Giamarellos-Bourboulis, Michael S Niederman
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引用次数: 0

Abstract

Purpose of review: Define the utility of adjunctive macrolide therapy in patients with more severe forms of community-acquired pneumonia (CAP).

Recent findings: Guidelines recommend adjunctive macrolide therapy as an option for patients with CAP, admitted to the hospital. A large data set collected both retrospectively and prospectively, including several recent randomized controlled trials (RCTs) have shown that adjunctive macrolide therapy can reduce mortality and improve outcomes in patients with severe CAP, more effectively than other alternative therapies. This effect appears to be most evident in those with severe illness and appears to be independent of direct antimicrobial effects and may be a result of the immunomodulatory properties of macrolides. A recent RCT, the ACCESS study, showed a clinical benefit of macrolides in severe CAP patients, but this may have been the result of a reversal of infection-related immunoparalysis. Macrolides appear to be valuable for patients with more severe CAP, but their therapeutic value is being challenged by the recent emergence of macrolide-resistant Mycoplasma pneumoniae; however, the optimal therapy for this pathogen still needs to be defined.

Summary: New evidence has further advanced the role of macrolides as preferred adjunctive therapy for patients with severe CAP.

大环内酯类药物在重症社区获得性肺炎中的作用及耐大环内酯类药物肺炎支原体的潜在影响。
综述的目的:明确大环内酯类药物辅助治疗在更严重的社区获得性肺炎(CAP)患者中的应用。最近的发现:指南推荐辅助大环内酯治疗作为住院CAP患者的一种选择。回顾性和前瞻性收集的大量数据集,包括最近的几项随机对照试验(rct)表明,辅助大环内酯治疗可以降低严重CAP患者的死亡率并改善预后,比其他替代治疗更有效。这种效果似乎在那些患有严重疾病的人身上最为明显,似乎与直接的抗菌作用无关,可能是大环内酯类药物免疫调节特性的结果。最近的一项随机对照试验ACCESS研究显示,大环内酯类药物对严重CAP患者有临床益处,但这可能是感染相关免疫瘫痪逆转的结果。大环内酯类药物似乎对更严重的CAP患者有价值,但其治疗价值受到最近出现的大环内酯类药物耐药肺炎支原体的挑战;然而,这种病原体的最佳治疗方法仍然需要确定。摘要:新的证据进一步表明大环内酯类药物作为严重CAP患者首选辅助治疗的作用。
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来源期刊
CiteScore
6.70
自引率
2.60%
发文量
121
审稿时长
6-12 weeks
期刊介绍: This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.
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