The efficacy and tolerance of
clarithromycin and
erythromycin stearate in the treatment of community-acquired
pneumonia were compared in a multicentre, double-blind randomized trial. Two hundred and eight adult patients were randomized to receive either
clarithromycin 250 mg 12-hourly (96 patients) or
erythromycin stearate 500 mg 6-hourly (112 patients), each for 14 days. One hundred and eight patients were evaluable for efficacy, 64 receiving
clarithromycin and 44
erythromycin stearate. There was no significant difference between the two groups in terms of clinical cure (52% for
clarithromycin, 40% for
erythromycin) or clinical success (clinical cure and improvement; 89% for
clarithromycin, 98% for
erythromycin stearate), or radiological response (90% for both groups). An intention-to-treat analysis, including all patients entering the study revealed significant differences in favour of
clarithromycin. The clinical cure rate after two weeks of treatment was 45% in those who received
clarithromycin compared with 25% in the
erythromycin stearate group (P = 0.003), whilst improvement in
cough was observed in 97% and 80% of patients receiving
clarithromycin and
erythromycin stearate, respectively (P = 0.07). Adverse effects, mainly gastrointestinal, caused discontinuation of treatment in 4% (4/96) patients in the
clarithromycin group in comparison with 19% (21/112) treated with
erythromycin stearate (P less than 0.01). These results demonstrate that
clarithromycin twice daily is at least as effective as four times daily
erythromycin stearate for the treatment of community-acquired
pneumonia and is better tolerated.