The safety of antimicrobials for the treatment of community-acquired pneumonia

ABSTRACT

Introduction: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, and its prevalence continues to increase. Despite the efficacy of antimicrobials, their safety and tolerability remain topics of interest and concern for clinicians and patients alike.

Areas covered: This review outlines the main antimicrobial classes recommended for the empirical treatment of CAP in current guidelines, together with a potential new class. Each pharmacological group underwent a safety evaluation based on all available data about drug-related toxicities. The authors also present their mechanisms of action, their pharmacokinetic and pharmacodynamic properties, and the main clinical studies.

Expert opinion: Overall, antimicrobials currently marketed for the treatment of CAP are well tolerated and generally safe. However, unusual and sometimes serious adverse effects can occur in susceptible populations. Attention should be paid to identifying patients at risk of developing drug-related toxicities because, although most effects are transient, some could be disabling, permanent, or even fatal. Post-marketing surveillance remains crucial for gathering data to overcome the limitations of preclinical and clinical studies in estimating the true prevalence of drug-related adverse events.

KEYWORDS:

• Adverse effects
• antimicrobial agents
• beta-lactam
• community-acquired pneumonia
• fluoroquinolones
• macrolides
• safety
• toxicity

Article highlights

• Empirical antibiotic treatment for CAP includes different antimicrobial classes that depend on infection severity and patient characteristics (e.g. drug allergies and comorbidities).

• Macrolides, beta-lactams, fluoroquinolones, and tetracyclines are generally safe and well-tolerated.

• Gastrointestinal disorders are the most frequently reported side effects among patients taking macrolides. Cardiac toxicity has also been reported in relation to their potential to prolong the QT interval. Non-pharmacological and pharmacological risk factors have been identified for cardiac toxicity.

• Treatment with beta-lactams, despite being considered among the safest antimicrobials, can be associated with allergic adverse events as well as gastrointestinal and neurologic disorders.

• The safety of fluoroquinolones has been thoroughly reviewed because of reports of rare and severe adverse events. Although gastrointestinal-related disorders are the most prevalent, their associated cardiovascular, musculoskeletal, and neurological toxicities have been decisive in restricting their use.

• Tetracyclines show relatively few side effects, with gastrointestinal distress the main concern. Due to their high affinity to bone and teeth they are contraindicated in children.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.