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Three Part Question

In [adults presenting with community acquired pneumonia] is [intravenous clarithromycin better than oral clarithromycin] in [improving outcome]?

Clinical Scenario

Your patient in the Emergency Department is diagnosed with Community Acquired Pneumonia and requires antibiotic treatment. You are advised by the Medical team to give a stat dose of oral Clarithromycin as research shows oral Clarithromycin is as effective as an intravenous Clarithromycin for treatment of Community Acquired Pneumonia, and provides a cost effective treatment

Search Strategy

Database: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations , Ovid MEDLINE(R) <1948 to May Week 4
2011>, Ovid OLDMEDLINE(R) <1946 to 1965
EMBASE 1980-May week 3 2011
The Cochrane Library April 2011

Medline: [exp Clarithromycin/ AND exp Infusions, Intravenous/ or exp Injections, Intravenous/] OR [exp Clarithromycin/ AND exp Pneumonia/]

Embase:[Clarithromycin.ti,ab] AND [Oral.ti,ab OR Intravenous.ti,ab] AND [(community AND acquired AND pneumonia).ti,ab ]

Search Outcome

Medline Ovid - 43 papers were found. No articles were relevant to answer the clinical question.

Cochrane – No relevant articles

EMBASE – 97 No relevant papers found

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

No published studies exist to answer the clinical question. Chu et al’s (1992) study on 22 healthy volunteers suggested near complete absorption of oral clarithromycin with marked first pass metabolism. The active metabolite of clarithrmocyin, which appears to have anti-microbial activity which may be additive or synergistic with the parent compound, demonstrated greater metabolite peak concentration with the oral preparation than with intravenous infusion.

Clinical Bottom Line

No firm recommendation can be made as there is no published clinical evidence. A randomised double blind controlled study will be required to answer the question.

References

1. Chu SY, Deaton R, Cavanaugh J. Absolute bioavailability of clarithromycin after oral administration in humans. Antimicrobial Agents & Chemotherapy 1992; 36(5):1147-1150.