The Role of Macrolides for the Management of Community-Acquired Pneumonia and Pneumonia by the Novel Coronavirus SARS-CoV-2 (COVID-19): A Position Paper by Four Medical Societies from Greece

Evangelos J Giamarellos-Bourboulis; George L Daikos; Panagiotis Gargalianos; Charalambos Gogos; Marios Lazanas; Periklis Panagopoulos; Garyphallia Poulakou; Helen Sambatakou; Michael Samarkos

doi:10.1007/s40121-021-00471-1

The Role of Macrolides for the Management of Community-Acquired Pneumonia and Pneumonia by the Novel Coronavirus SARS-CoV-2 (COVID-19): A Position Paper by Four Medical Societies from Greece

Infect Dis Ther. 2021 Jun 16:1-15. doi: 10.1007/s40121-021-00471-1. Online ahead of print.

Authors

Evangelos J Giamarellos-Bourboulis¹, George L Daikos², Panagiotis Gargalianos³, Charalambos Gogos⁴, Marios Lazanas⁵, Periklis Panagopoulos⁶, Garyphallia Poulakou⁷, Helen Sambatakou⁸, Michael Samarkos²

Affiliations

¹ 4th Department of Internal Medicine, ATTIKON University Hospital, 1 Rimini Street, 124 62 Athens, Greece.
² 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
³ Department of Internal Medicine, Iatriko Athinon, Athens, Greece.
⁴ Department of Internal Medicine, Medical School, University of Patras, Patras, Greece.
⁵ Department of Internal Medicine, Iaso General Athens Hospital, Athens, Greece.
⁶ 2nd Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
⁷ 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁸ 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

PMID: 34155472
DOI: 10.1007/s40121-021-00471-1

Abstract

In light of the accumulating evidence for survival benefit coming from the use of macrolides for community-acquired pneumonia (CAP), a group of experts from the field of internal medicine and infectious diseases frame a position statement on the use of macrolides for the management of bacterial CAP and for infection by the novel coronavirus (COVID-19). The statement is framed taking into consideration existing publications and own research experience. The main content of this statement is that the combination of one β-lactam and a macrolide should be the first treatment of choice for patients with severe bacterial CAP. Severity is assessed as scoring 2 or more points on the CURB65 scoring system of severity or as pneumonia severity index III to V or C-reactive protein more than 150 mg/l; the suggested macrolide is either azithromycin or clarithromycin. The experts also suggest that in COVID-19 pneumonia, the combination of one β-lactam and a macrolide should be reserved only when there is strong suspicion of bacterial co-infection.

Keywords: Azithromycin; COVID-19; Clarithromycin; Community-acquired pneumonia; Immunomodulation.

Associated data

figshare/10.6084/m9.figshare.14672379