{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:38:25Z","timestamp":1791441505159,"version":"4.3.3"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100001502","name":"Blue Cross Blue Shield of Michigan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001502","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Blue Care Network"},{"name":"BCBSM","id":[{"id":"https:\/\/ror.org\/00q2zjc87","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>There remains equipoise regarding the benefit of empiric azithromycin with beta-lactam therapy in patients hospitalized with nonsevere community-acquired pneumonia (CAP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a target trial emulation using a propensity-weighted cohort from 68 hospitals in Michigan. Adult patients hospitalized with nonsevere CAP receiving beta-lactam antimicrobial therapy with or without azithromycin were included. CAP was defined based on the International Classification of Diseases, Tenth Revision, discharge diagnosis code of pneumonia and \u22652 signs\/symptoms of pneumonia with radiographic findings. The primary outcome was time (days) to clinical stability. Secondary outcomes included composite 30-day mortality and rehospitalization, intensive care unit (ICU) transfer, and antibiotic duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 66 657 patients hospitalized for CAP between September 2015 and July 2024, 28.5% (19 010) met inclusion criteria, of whom 93.8% (17 822 of 19 010) received empiric azithromycin. After inverse probability of treatment weighting, there was no difference in time to clinical stability for those reciving azithromycin (vs not) (3 [interquartile range, IQR 3\u20134] vs 3 days [IQR 3\u20134]; adjusted hazard ratio [aHR], 1.00 [0.96\u20131.05]; P = .91). Empiric azithromycin was associated with lower composite 30-day mortality and rehospitalization (10.8% vs 15.1%; aHR, 0.73 [0.62\u20130.87]; P = .0004). There were no differences in ICU transfer (0.9% vs 1.4%; aHR, 0.85 [0.48\u20131.49]; P = .57) or total antibiotic duration (6 [IQR 5\u20138] vs 7 [IQR 5\u20139] days, P = .23).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adding azithromycin to beta-lactam therapy in patients hospitalized with nonsevere CAP was not associated with time to clinical stability but was associated with lower composite 30-day mortality and rehospitalization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag222","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:40:08Z","timestamp":1775043608000},"page":"484-492","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes Associated With Empiric Azithromycin Use Among Patients Hospitalized With Nonsevere Community-Acquired Pneumonia: Emulation of a Target Trial"],"prefix":"10.1093","volume":"83","author":[{"given":"Ashwin B","family":"Gupta","sequence":"first","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]},{"name":"Medicine Service, VA Ann Arbor Healthcare System , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1760-976X","authenticated-orcid":false,"given":"Emily","family":"Walzl","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ratz","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research, VA Ann Arbor Health System , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2545-0636","authenticated-orcid":false,"given":"Jennifer K","family":"Horowitz","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"McLaughlin","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Pearlman","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7645-5147","authenticated-orcid":false,"given":"Tawny","family":"Czilok","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tejal","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay A","family":"Petty","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anurag N","family":"Malani","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Trinity Health Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5809-7149","authenticated-orcid":false,"given":"David","family":"Paje","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]},{"name":"Medicine Service, VA Ann Arbor Healthcare System , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preeti","family":"Misra","sequence":"additional","affiliation":[{"name":"Department of Medicine, Trinity Health Michigan , Livonia, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Kaatz","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Henry Ford Health , Detroit, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Medicine Service, VA Ann Arbor Healthcare System , Ann Arbor, Michigan ,","place":["USA"]},{"name":"Center for Clinical Management Research, VA Ann Arbor Health System , Ann Arbor, Michigan ,","place":["USA"]},{"name":"Division of General Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1112-7392","authenticated-orcid":false,"given":"Mariam","family":"Younas","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Hurley Medical Center , Flint, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A","family":"Flanders","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4362-7842","authenticated-orcid":false,"given":"Valerie M","family":"Vaughn","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan ,","place":["USA"]},{"name":"Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine , Salt Lake City, Utah ,","place":["USA"]},{"name":"Division of Health System Innovation and Research, Department of Population Health Science, University of Utah School of Medicine , Salt Lake City, Utah 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