The ACCESS trial ( Lancet Respir Med 2024;12(4):294–304) provides new evidence supporting the use of macrolides in community-acquired pneumonia (CAP). In this prospective, double-blind study, Giamarellos-Bourboulis and colleagues randomised patients admitted with CAP and receiving intravenous antibiotics to addition of either oral clarithromycin or placebo for 7 days. Participants from 18 Greek hospitals were enrolled, with CAP defined as consolidation on chest radiograph with compatible auscultatory findings or consolidation on CT, though a pathogen was only identified in 55% of the study population (most commonly Staphylococcus aureus ). Inclusion criteria limited the study to a subset of hospital patients with systemic inflammation, requiring two positive criteria of systemic inflammatory response syndrome, a sequential organ failure assessment (SOFA) score of≥2, and a procalcitonin of≥0.25 ng/mL. The primary outcome was achievement at day 4 of both an ‘early clinical response’ (≥50% decrease in respiratory symptom score) and an ‘early inflammatory response’ (≥30% decrease in SOFA score and/or procalcitonin decrease by≥80% or to<0.25 ng/mL). This endpoint was met in 68% (n=91) of patients treated with clarithromycin, compared with 38% (n=51) in the placebo group (OR 3.40 (95% CI 2.06 to 5.63), p<0.0001). Secondary analyses revealed that clarithromycin significantly reduced the rate of progression to organ dysfunction and recurrent sepsis, and shortened time to hospital …

中文翻译：

---

 期刊俱乐部


ACCESS 试验（柳叶刀 Respir Med 2024;12（4）：294–304） 提供了支持在社区获得性肺炎 （CAP） 中使用大环内酯类药物的新证据。在这项前瞻性双盲研究中，Giamarellos-Bourboulis 及其同事将接受静脉注射抗生素的 CAP 入院患者随机分配至联合口服克拉霉素或安慰剂组，为期 7 天。来自 18 家希腊医院的参与者被纳入，CAP 定义为胸片实变伴相容的听诊结果或 CT 实变，尽管仅在 55% 的研究人群中发现病原体（最常见的是金黄色葡萄球菌）。纳入标准将研究限制在患有全身炎症的医院患者亚组，需要两个全身炎症反应综合征的阳性标准，序贯器官衰竭评估 （SOFA） 评分为 ≥2，降钙素原为 ≥0.25 ng/mL。主要结局是在第 4 天达到“早期临床反应”（呼吸系统症状评分降低 ≥50%）和“早期炎症反应”（SOFA 评分降低 ≥30% 和/或降钙素原降低 ≥80% 或至 <0.25 ng/mL）。68% （n=91） 接受克拉霉素治疗的患者达到该终点，而安慰剂组为 38% （n=51） （OR 3.40 （95% CI 2.06 至 5.63），p<0.0001）。二次分析显示，克拉霉素显着降低了进展为器官功能障碍和复发性败血症的速度，并缩短了住院时间......