RESUMO
WHAT IS KNOWN AND OBJECTIVE: Healthcare-associated pneumonia (HCAP) is an important presentation among hospitalized patients. Standardized definitions of this entity are almost a decade old, and practice patterns have shifted from published guidelines to include empiric coverage with a macrolide, such as azithromycin. Azithromycin is oftentimes included in the empiric treatment regimen for HCAP because of the importance of appropriate empiric antimicrobial coverage, the perceived concern regarding atypical organisms, potential anti-inflammatory effects of the medication, and positive clinical data among patients with Streptococcal bacteremia. METHODS: In this review, we systematically investigate data for each of these topics along with clinical data examining the role of azithromycin in HCAP. RESULTS AND DISCUSSION: Our findings indicate that atypical organisms are rare in HCAP, that the anti-inflammatory actions of azithromycin - although promising - have not produced consistently positive effects in many chronic or acute conditions, and that the data available for azithromycin use in bacteremia are of low quality. A single-centre cohort indicated that the clinical benefits of azithromycin did not extend to HCAP compared to community-acquired pneumonia. WHAT IS NEW AND CONCLUSION: Additionally, there are newer data emphasizing the potential cardiotoxicity of azithromycin, particularly among patients at high risk. All of these data indicate that azithromycin should not be part of the standard empiric treatment for HCAP.