{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:02:59Z","timestamp":1793037779498,"version":"4.5.0"},"reference-count":19,"publisher":"European Respiratory Society (ERS)","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Breathe"],"accepted":{"date-parts":[[2025,6,19]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>This Journal club aims to evaluate the recent evidence about the potential benefits of macrolides as add-on therapy in the treatment of community-acquired pneumonia (CAP), an area where the data remain conflicting. Four studies with diverse methodology (the ACCESS trial, a Greek cohort study, a UK-based cohort study and a recent meta-analysis) have aimed to assess either potential immunomodulatory effects, clinical response or hard end-points like mortality when macrolides are added to the treatment regimen for hospitalised patients with CAP. The ACCESS trial, a randomised controlled trial (RCT), demonstrated improved early clinical response and immunomodulatory effects with clarithromycin, while the Greek cohort study showed reduced 28-day mortality and delayed organ dysfunction with clarithromycin. The cohort study from the UK found no added benefit of macrolides on 30-day mortality or decline in Sequential Organ Failure Assessment score. The recent meta-analysis supported a survival advantage of macrolides, favouring clarithromycin over azithromycin. However, study limitations like heterogeneity, confounding risks and the lack of head-to-head comparisons of individual macrolides remain of concern. Macrolide treatment decisions may benefit from individualised risk assessment; however, future research should focus on identifying subgroups who might benefit from macrolides and comparative analyses of macrolide agents through large-scale RCTs.<\/jats:p>","DOI":"10.1183\/20734735.0190-2025","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T14:06:10Z","timestamp":1760450770000},"page":"250190","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["The use of macrolides in the treatment of community-acquired pneumonia: risks and benefits"],"prefix":"10.1183","volume":"21","author":[{"given":"Fatimah","family":"Al-Zergani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0653-1289","authenticated-orcid":false,"given":"Simone","family":"Bastrup Israelsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Benfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1339-2918","authenticated-orcid":false,"given":"Markus","family":"Fally","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"2025122210053502000_21.4.250190.1","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1080\/21645515.2017.1300730","article-title":"Burden of community-acquired pneumonia in adults over 18 y of age","volume":"13","author":"Kosar","year":"2017","journal-title":"Hum Vaccin Immunother"},{"key":"2025122210053502000_21.4.250190.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-023-07033-8"},{"key":"2025122210053502000_21.4.250190.3","doi-asserted-by":"publisher","DOI":"10.1086\/511159"},{"key":"2025122210053502000_21.4.250190.4","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-014-2067-1"},{"key":"2025122210053502000_21.4.250190.5","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-208599"},{"key":"2025122210053502000_21.4.250190.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.14796"},{"key":"2025122210053502000_21.4.250190.7","doi-asserted-by":"crossref","first-page":"E1628","DOI":"10.21037\/jtd.2016.12.52","article-title":"Shorter antibiotic courses in community-acquired pneumonia\u2014ready for prime time","volume":"8","author":"Shaddock","year":"2016","journal-title":"J Thorac Dis"},{"key":"2025122210053502000_21.4.250190.8","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1111\/resp.12835","article-title":"Beta-lactam plus macrolides or beta-lactam alone for community-acquired pneumonia: a systematic review and meta-analysis","volume":"21","author":"Horita","year":"2016","journal-title":"Respirology"},{"key":"2025122210053502000_21.4.250190.9","doi-asserted-by":"crossref","first-page":"1117254","DOI":"10.3389\/fcvm.2023.1117254","article-title":"Administration of macrolide antibiotics increases cardiovascular risk","volume":"10","author":"Wu","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"2025122210053502000_21.4.250190.10","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/S2213-2600(23)00412-5","article-title":"Clarithromycin for early anti-inflammatory responses in community-acquired pneumonia in Greece (ACCESS): a randomised, double-blind, placebo-controlled trial","volume":"12","author":"Giamarellos-Bourboulis","year":"2024","journal-title":"Lancet Respir Med"},{"key":"2025122210053502000_21.4.250190.11","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2017.03.125"},{"key":"2025122210053502000_21.4.250190.12","doi-asserted-by":"crossref","first-page":"105836","DOI":"10.1016\/j.ijantimicag.2019.10.017","article-title":"Survival benefit associated with clarithromycin in severe community-acquired pneumonia: a matched comparator study","volume":"55","author":"Kyriazopoulou","year":"2020","journal-title":"Int J Antimicrob Agents"},{"key":"2025122210053502000_21.4.250190.13","doi-asserted-by":"crossref","first-page":"e713","DOI":"10.1093\/infdis\/jiae639","article-title":"Addition of macrolide antibiotics for hospital treatment of community-acquired pneumonia","volume":"231","author":"Wei","year":"2025","journal-title":"J Infect Dis"},{"key":"2025122210053502000_21.4.250190.14","doi-asserted-by":"crossref","first-page":"106942","DOI":"10.1016\/j.ijantimicag.2023.106942","article-title":"Macrolides for better resolution of community-acquired pneumonia: a global meta-analysis of clinical outcomes with focus on microbial aetiology","volume":"62","author":"Kyprianou","year":"2023","journal-title":"Int J Antimicrob Agents"},{"key":"2025122210053502000_21.4.250190.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)07451-2"},{"key":"2025122210053502000_21.4.250190.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.09.029"},{"key":"2025122210053502000_21.4.250190.17","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1001\/jamainternmed.2014.4887","article-title":"\u03b2-Lactam monotherapy vs \u03b2-lactam\u2013macrolide combination treatment in moderately severe community-acquired pneumonia: a randomized noninferiority trial","volume":"174","author":"Garin","year":"2014","journal-title":"JAMA Intern Med"},{"key":"2025122210053502000_21.4.250190.18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1406330"},{"key":"2025122210053502000_21.4.250190.19","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00824-2019"}],"container-title":["Breathe"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/20734735.0190-2025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T18:05:45Z","timestamp":1766426745000},"score":1,"resource":{"primary":{"URL":"http:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/20734735.0190-2025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,10,14]]},"published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1183\/20734735.0190-2025"],"URL":"https:\/\/doi.org\/10.1183\/20734735.0190-2025","relation":{},"ISSN":["1810-6838","2073-4735"],"issn-type":[{"value":"1810-6838","type":"print"},{"value":"2073-4735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}