{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T17:58:21Z","timestamp":1770832701499,"version":"3.50.1"},"reference-count":57,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T00:00:00Z","timestamp":1683676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health, Labour, and Welfare, Japan","award":["JP20AA2005"],"award-info":[{"award-number":["JP20AA2005"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>The potential antimicrobial and anti-inflammatory effectiveness of azithromycin against severe influenza is yet unclear. We retrospectively investigated the effect of intravenous azithromycin administration within 7 days of hospitalization in patients with influenza virus pneumonia and respiratory failure. Using Japan\u2019s national administrative database, we enrolled and classified 5066 patients with influenza virus pneumonia into severe, moderate, and mild groups based on their respiratory status within 7 days of hospitalization. The primary endpoints were total, 30-day, and 90-day mortality rates. The secondary endpoints were the duration of intensive-care unit management, invasive mechanical ventilation, and hospital stay. The inverse probability of the treatment weighting method with estimated propensity scores was used to minimize data collection bias. Use of intravenous azithromycin was proportional to the severity of respiratory failure (mild: 1.0%, moderate: 3.1%, severe: 14.8%). In the severe group, the 30-day mortality rate was significantly lower with azithromycin (26.49% vs. 36.65%, p = 0.038). In the moderate group, the mean duration of invasive mechanical ventilation after day 8 was shorter with azithromycin; there were no significant differences in other endpoints between the severe and moderate groups. These results suggest that intravenous azithromycin has favorable effects in patients with influenza virus pneumonia using mechanical ventilation or oxygen.<\/jats:p>","DOI":"10.3390\/v15051142","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T01:37:09Z","timestamp":1683769029000},"page":"1142","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Administering Intravenous Azithromycin within 7 Days of Hospitalization for Influenza Virus Pneumonia: A Propensity Score Analysis Using a Nationwide Administrative Database"],"prefix":"10.3390","volume":"15","author":[{"given":"Takatomo","family":"Tokito","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8338-0608","authenticated-orcid":false,"given":"Takashi","family":"Kido","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9445-6345","authenticated-orcid":false,"given":"Keiji","family":"Muramatsu","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan, Kitakyushu 807-0804, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2653-1670","authenticated-orcid":false,"given":"Kei","family":"Tokutsu","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan, Kitakyushu 807-0804, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Okuno","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirokazu","family":"Yura","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0373-0618","authenticated-orcid":false,"given":"Shinnosuke","family":"Takemoto","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Ishimoto","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0696-5386","authenticated-orcid":false,"given":"Takahiro","family":"Takazono","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"},{"name":"Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7577-476X","authenticated-orcid":false,"given":"Noriho","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8838-7403","authenticated-orcid":false,"given":"Yasushi","family":"Obase","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuji","family":"Ishimatsu","sequence":"additional","affiliation":[{"name":"Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9126-206X","authenticated-orcid":false,"given":"Yoshihisa","family":"Fujino","sequence":"additional","affiliation":[{"name":"Department of Environmental Epidemiology, Institute of Industrial Ecological Science, University of Occupational and Environmental Health, Japan, Kitakyushu 807-0804, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2955-4432","authenticated-orcid":false,"given":"Kazuhiro","family":"Yatera","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu 807-0804, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiyohide","family":"Fushimi","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan, Tokyo 113-8519, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinya","family":"Matsuda","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan, Kitakyushu 807-0804, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Mukae","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1016\/S0140-6736(03)14854-4","article-title":"Influenza","volume":"362","author":"Nicholson","year":"2003","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1093\/cid\/ciq012","article-title":"Estimating the Burden of 2009 Pandemic Influenza A (H1N1) in the United States (April 2009\u2013April 2010)","volume":"52","author":"Shrestha","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1016\/S0140-6736(17)33293-2","article-title":"Estimates of Global Seasonal Influenza-associated Respiratory Mortality: A Modelling Study","volume":"391","author":"Iuliano","year":"2018","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.amepre.2021.11.007","article-title":"Impact of Low Rates of Influenza on Next-season Influenza Infections","volume":"62","author":"Krauland","year":"2022","journal-title":"Am. J. Prev. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"ofab607","DOI":"10.1093\/ofid\/ofab607","article-title":"Estimating the Impact of Low Influenza Activity in 2020 on Population Immunity and Future Influenza Seasons in the United States","volume":"9","author":"Lee","year":"2021","journal-title":"Open Forum Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1001\/jama.2021.24315","article-title":"Winter of Omicron-The Evolving COVID-19 Pandemic","volume":"327","author":"Omer","year":"2022","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Hong, W.C., Sun, S.F., Hsu, C.W., Lee, D.L., and Lee, C.H. (2021). Clinical Characteristics and Predictors of Mortality in Critically Ill Adult Patients with Influenza Infection. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18073682"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1056\/NEJMoa2021436","article-title":"Dexamethasone in Hospitalized Patients with COVID-19","volume":"384","author":"Horby","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1056\/NEJMoa2031994","article-title":"Baricitinib plus Remdesivir for Hospitalized Adults with COVID-19","volume":"384","author":"Kalil","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1001\/jama.2021.11330","article-title":"Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19: A Meta-Analysis","volume":"326","author":"Vale","year":"2021","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e172","DOI":"10.1093\/cid\/ciu632","article-title":"Evaluation of Intravenous Peramivir for Treatment of Influenza in Hospitalized Patients","volume":"59","author":"Ison","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2803","DOI":"10.1128\/AAC.01718-10","article-title":"Intravenous Peramivir for Treatment of Influenza A and B Virus Infection in High-risk Patients","volume":"55","author":"Kohno","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Okuno, D., Kido, T., Muramatsu, K., Tokutsu, K., Moriyama, S., Miyamura, T., Hara, A., Ishimoto, H., Yamaguchi, H., and Miyazaki, T. (2021). Impact of Corticosteroid Administration Within 7 Days of the Hospitalization for Influenza Pneumonia with Respiratory Failure: A Propensity Score Analysis Using a Nationwide Administrative Database. J. Clin. Med., 10.","DOI":"10.3390\/jcm10030494"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s13054-019-2395-8","article-title":"The Effect of Corticosteroids on Mortality of Patients with Influenza Pneumonia: A Systematic Review and Meta-analysis","volume":"23","author":"Ni","year":"2019","journal-title":"Crit. Care"},{"key":"ref_15","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":"ref_16","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1378\/chest.11-1908","article-title":"Macrolide Antibiotics and Survival in Patients with Acute Lung Injury","volume":"141","author":"Walkey","year":"2012","journal-title":"Chest"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.antiviral.2017.05.008","article-title":"Anti-inflammatory Effects of Adjunctive Macrolide Treatment in Adults Hospitalized with Influenza: A Randomized Controlled Trial","volume":"144","author":"Lee","year":"2017","journal-title":"Antivir. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"12","author":"Altman","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2188\/jea.JE20200288","article-title":"History and Profile of Diagnosis Procedure Combination (DPC): Development of a Real Data Collection System for Acute Inpatient Care in Japan","volume":"31","author":"Hayashida","year":"2021","journal-title":"J. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kido, T., Muramatsu, K., Asakawa, T., Otsubo, H., Ogoshi, T., Oda, K., Kubo, T., Fujino, Y., Matsuda, S., and Mayumi, T. (2018). The Relationship Between High-dose Corticosteroid Treatment and Mortality in Acute Respiratory Distress Syndrome: A Retrospective and Observational Study Using a Nationwide Administrative Database in Japan. BMC Pulm. Med., 18.","DOI":"10.1186\/s12890-018-0597-5"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1111\/resp.12969","article-title":"Efficacy of Early Sivelestat Administration on Acute Lung Injury and Acute Respiratory Distress Syndrome","volume":"22","author":"Kido","year":"2017","journal-title":"Respirology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1097\/CCM.0000000000000150","article-title":"Postoperative Polymyxin B Hemoperfusion and Mortality in Patients with Abdominal Septic Shock: A Propensity-matched Analysis","volume":"42","author":"Iwagami","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2837","DOI":"10.1002\/sim.5705","article-title":"The Performance of Different Propensity Score Methods for Estimating Marginal Hazard Ratios","volume":"32","author":"Austin","year":"2013","journal-title":"Stat Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/ckj\/sfab158","article-title":"An Introduction to Inverse Probability of Treatment Weighting in Observational Research","volume":"15","author":"Chesnaye","year":"2021","journal-title":"Clin. Kidney J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1056\/NEJMoa050333","article-title":"Incidence and Outcomes of Acute Lung Injury","volume":"353","author":"Rubenfeld","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"18406","DOI":"10.1038\/s41598-019-54922-4","article-title":"Azithromycin Combination Therapy for Community-acquired Pneumonia: Propensity Score Analysis","volume":"9","author":"Ito","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3000605211049943","DOI":"10.1177\/03000605211049943","article-title":"Comparative Efficacy of Azithromycin Versus Clarithromycin in Combination with Beta-lactams to Treat Community-acquired Pneumonia in Hospitalized Patients: A Systematic Review","volume":"49","author":"Gillani","year":"2021","journal-title":"J. Int. Med. Res."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Falcone, M., Russo, A., Shindo, Y., Farcomeni, A., Pieralli, F., Cangemi, R., Liu, J., Xia, J., Okumura, J., and Sano, M. (2019). A Hypothesis-Generating Study of the Combination of Aspirin plus Macrolides in Patients with Severe Community-Acquired Pneumonia. Antimicrob. Agents Chemother., 63.","DOI":"10.1128\/AAC.01556-18"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"791163","DOI":"10.3389\/fmed.2021.791163","article-title":"Acute Respiratory Distress Syndrome Caused by Human Adenovirus in Adults: A Prospective Observational Study in Guangdong, China","volume":"8","author":"Wu","year":"2021","journal-title":"Front. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.ijantimicag.2018.02.009","article-title":"Adjunctive therapy with azithromycin for moderate and severe acute respiratory distress syndrome: A retrospective, propensity score-matching analysis of prospectively collected data at a single center","volume":"51","author":"Kawamura","year":"2018","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1159\/000358443","article-title":"Efficacy of Azithromycin for Treatment of Acute Exacerbation of Chronic Fibrosing Interstitial Pneumonia: A Prospective, Open-label Study with Historical Controls","volume":"87","author":"Kawamura","year":"2014","journal-title":"Respiration"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kawamura, K., Ichikado, K., Yasuda, Y., Anan, K., and Suga, M. (2017). Azithromycin for Idiopathic Acute Exacerbation of Idiopathic Pulmonary Fibrosis: A Retrospective Single-center Study. BMC Pulm. Med., 17.","DOI":"10.1186\/s12890-017-0437-z"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1016\/j.chest.2016.11.012","article-title":"Efficacy of Clarithromycin-naproxen-oseltamivir Combination in the Treatment of Patients Hospitalized for Influenza A(H3N2) Infection: An Open-label Randomized, Controlled, Phase Iib\/III trial","volume":"151","author":"Hung","year":"2017","journal-title":"Chest"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.resinv.2014.05.001","article-title":"Additional Treatment with Clarithromycin Reduces Fever Duration in Patients with Influenza","volume":"52","author":"Higashi","year":"2014","journal-title":"Respir. Investig."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.resinv.2017.07.005","article-title":"The Additive Effect of Clarithromycin on Influenza A Infection in the Elderly Patients and Patients with Comorbid Diseases","volume":"55","author":"Yatera","year":"2017","journal-title":"Respir. Investig."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Kakeya, H., Seki, M., Izumikawa, K., Kosai, K., Morinaga, Y., Kurihara, S., Nakamura, S., Imamura, Y., Miyazaki, T., and Tsukamoto, M. (2014). Efficacy of Combination Therapy with Oseltamivir Phosphate and Azithromycin for Influenza: A Multicenter, Open-label, Randomized Study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0091293"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1007\/s00134-013-2829-8","article-title":"Macrolide-based Regimens in Absence of Bacterial Co-infection in Critically Ill H1N1 Patients with Primary Viral Pneumonia","volume":"39","author":"Granada","year":"2013","journal-title":"Intensive Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2040206620961712","DOI":"10.1177\/2040206620961712","article-title":"Clinical Evidences on the Antiviral Properties of Macrolide Antibiotics in the COVID-19 Era and Beyond","volume":"28","author":"Poddighe","year":"2020","journal-title":"Antivir. Chem. Chemother."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"112739","DOI":"10.1016\/j.ejmech.2020.112739","article-title":"Azithromycin: The First Broad-spectrum Therapeutic","volume":"207","author":"Firth","year":"2020","journal-title":"Eur. J. Med. Chem."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1128\/CMR.00078-09","article-title":"Mechanisms of Action and Clinical Application of Macrolides as Immunomodulatory Medications","volume":"23","author":"Kanoh","year":"2010","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"106053","DOI":"10.1016\/j.ijantimicag.2020.106053","article-title":"Macrolides and Viral Infections: Focus on Azithromycin in COVID-19 Pathology","volume":"56","author":"Pani","year":"2020","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e12953","DOI":"10.1111\/cpr.12953","article-title":"Direct Inhibitory Effect on Viral Entry of Influenza A and SARS-CoV-2 Viruses by Azithromycin","volume":"54","author":"Du","year":"2021","journal-title":"Cell Prolif."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e2163","DOI":"10.1002\/rmv.2163","article-title":"Azithromycin in Viral Infections","volume":"31","author":"Oliver","year":"2021","journal-title":"Rev. Med. Virol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/S0140-6736(21)00149-5","article-title":"Azithromycin in Patients Admitted to Hospital with COVID-19 (RECOVERY): A Randomised, Controlled, Open-label, Platform Trial","volume":"397","author":"Abaleke","year":"2021","journal-title":"Lancet"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1016\/S2213-2600(21)00263-0","article-title":"Azithromycin Versus Standard Care in Patients with Mild-to-Moderate COVID-19 (ATOMIC2): An Open-label, Randomised Trial","volume":"9","author":"Hinks","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1753466620963026","DOI":"10.1177\/1753466620963026","article-title":"Development of Secondary Bacterial Pneumonia in Adults Presenting with Influenza Versus Noninfluenza Viral Respiratory Infection","volume":"14","author":"Melamed","year":"2020","journal-title":"Ther. Adv. Respir. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"166","DOI":"10.2353\/ajpath.2010.100115","article-title":"2009 Pandemic Influenza A (H1N1): Pathology and Pathogenesis of 100 Fatal Cases in the United States","volume":"177","author":"Shieh","year":"2010","journal-title":"Am. J. Pathol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"420","DOI":"10.3389\/fmed.2020.00420","article-title":"Secondary Bacterial Infections in Patients with Viral Pneumonia","volume":"7","author":"Manohar","year":"2020","journal-title":"Front. Med."},{"key":"ref_49","unstructured":"The Japanese Respiratory Society (2017). The JRS Guidelines for the Management of Pneumonia in Adults 2017, The Japanese Respiratory Society. (In Japanese)."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.3389\/fmicb.2017.01041","article-title":"Secondary Bacterial Infections Associated with Influenza Pandemics","volume":"8","author":"Morris","year":"2017","journal-title":"Front. Microbiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1128\/CMR.00058-05","article-title":"Insights into the Interaction Between Influenza Virus and Pneumococcus","volume":"19","author":"McCullers","year":"2006","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e002898","DOI":"10.1136\/bmjopen-2013-002898","article-title":"Azithromycin and Survival in Streptococcus pneumoniae Pneumonia: A Retrospective Study","volume":"3","author":"Shorr","year":"2013","journal-title":"BMJ Open"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.ijantimicag.2014.12.034","article-title":"Killing of Streptococcus pneumoniae by Azithromycin, Clarithromycin, Erythromycin, Telithromycin and Gemifloxacin Using Drug Minimum Inhibitory Concentrations and Mutant Prevention Concentrations","volume":"45","author":"Blondeau","year":"2015","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"106307","DOI":"10.1016\/j.rmed.2021.106307","article-title":"Pneumococal Community-acquired Pneumonia in the Intensive Care Unit: Azithromycin Remains Protective Despite Macrolide Resistance","volume":"177","author":"Shorr","year":"2021","journal-title":"Respir. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"527","DOI":"10.2169\/internalmedicine.48.1482","article-title":"Efficacy of Azithromycin in the Treatment of Community-acquired Pneumonia, Including Patients with Macrolide-resistant Streptococcus pneumoniae Infection","volume":"48","author":"Yanagihara","year":"2009","journal-title":"Intern. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.pharmthera.2014.03.003","article-title":"Azithromycin: Mechanisms of Action and Their Relevance for Clinical Applications","volume":"143","author":"Parnham","year":"2014","journal-title":"Pharmacol. Ther."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1001\/jama.2014.4304","article-title":"Association of Azithromycin with Mortality and Cardiovascular Events Among Older Patients Hospitalized with Pneumonia","volume":"311","author":"Mortensen","year":"2014","journal-title":"JAMA"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/5\/1142\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:32:25Z","timestamp":1760124745000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/5\/1142"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,10]]},"references-count":57,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["v15051142"],"URL":"https:\/\/doi.org\/10.3390\/v15051142","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,10]]}}}