The efficacy and tolerance of
clarithromycin (250 mg twice daily) were compared with those of
roxithromycin (150 mg twice daily) in an open, multicentre trial of 77 inpatients with community-acquired
pneumonia. Sixty-five patients were clinically evaluable (34,
clarithromycin; 31
roxithromycin). Efficacy was comparable between treatment groups: 26 of 34 patients (76%) treated with
clarithromycin were clinically cured, including four with atypical
pneumonia. In the
roxithromycin group 25 of 31 patients (81%) were clinically cured and one was improved.
Cough, appearance of sputum, and
fever improved in most patients in both treatment groups. Chest X-rays
after treatment showed resolution or improvement in 76% of patients who received
clarithromycin and 87% of those who received
roxithromycin. The clinical evaluation of the response generally agreed with the bacteriological response. Among patients who were bacteriologically evaluable for four target organisms (Streptococcus pneumoniae, Haemophilus influenzae, H. parainfluenzae, and Branhamella catarrhalis) the pathogen was eradicated in four of seven (57%) in the
clarithromycin-treated group and in five of six (83%) in the
roxithromycin-treated group. Adverse events were reported in more patients who received
roxithromycin (21.6%) than in those who received
clarithromycin (12.5%) although the incidences were not statistically significantly different. The majority of adverse events were transient increases in serum
alanine aminotransferase, serum
aspartate aminotransferase, and
alkaline phosphatase.
Clarithromycin was shown to be effective and well-tolerated; the clinical efficacy and safety of
clarithromycin and
roxithromycin were comparable.