Evaluation of azithromycin in the treatment of pneumonia in ambulatory children: A randomized trial employing amoxicillin clavulanate or erythrotnycin estolate as comparative standard therapy

Community acquired pneumonia(CAP)in adults is commonly caused by viruses, bacteria, Mycoplasma pneumoniae(MP), and Chlamydia pneumoniae (CP), but there is less information about etiology in ambulatory children. In this single center ongoing prospective study we evaluated patients from 6 months to 16 yeans of age with radiographic and clinical evidence of pneumonia. Children were randomized 1:1 to receive azithromycin(azi)qd × 5days or augmentin(aug) and erythromycin(ery) TID x 10 days for those </=5 and >5 years, respectively. Patient samples were collected at diagnosis and again 2-3 weeks later. Between February 1996-Feb 1997, 111 patients were enrolled. There were 52% males and 64% were < 5 years. All blood cultures were sterile. Etiologic agents were identified by serology, NP/throat culture and PCR in 35/111(32%)patients. Organisms included MP 8(7.2%), CP 7(6.3%), RSV 10(9%), influenza A 4(3.6%), parainfluenza 2(1.8%), adenovirus 1(0.9%), enterovirus 1(0.9%), influenza B 1(0.9%) and CMV 1(0.9%). Two children had positive PPD's. MP and CP were not found by culture or PCR in healthy control children. Cure/improvement for azi was 43/44(98%) verses ery/aug 47/48(98%). To date MP and CP appear to be less common etiologies of CAP in Dallas than reported elsewhere in the United States.