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Journal of Antimicrobial Chemotherapy (2001) 48, 677-689
© 2001 The British Society for Antimicrobial Chemotherapy

Meta-analysis of randomized controlled trials on the comparative efficacy and safety of azithromycin against other antibiotics for upper respiratory tract infections

John P. A. Ioannidisa,b, Despina G. Contopoulos-Ioannidisa,c, Priscilla Chewb and Joseph Laub,*

a Clinical Trials and Evidence-Based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece; b Division of Clinical Care Research, New England Medical Center, Department of Medicine, Tufts University School of Medicine, 750 Washington Street, Box 63, Boston, MA 02111; c Department of Pediatrics, George Washington University School of Medicine, Washington, DC 20010, USA

We carried out a meta-analysis of randomized controlled trials comparing 3–5 days of azithromycin with other antibiotics that are typically given in longer courses for the treatment of upper respiratory tract infections. For acute otitis media (19 comparisons including 3421 patients), acute sinusitis (11 comparisons including 1742 patients) and acute pharyngitis (16 comparisons including 2447 patients), azithromycin had similar clinical failure rates to the other antibiotics [random effects odds ratios 1.12, 95% confidence interval (CI) 0.81–1.54; 0.91, 95% CI 0.60–1.39; and 1.07, 95% CI 0.59–1.94, respectively]. The difference in clinical failures was <0.5%, and no 95% CIs exceeded 2.0%. There was no heterogeneity between studies. Subtle differences between comparators could have been due to chance. There were no significant differences in bacteriological outcomes. Azithromycin was discontinued because of adverse events in only 37 of 4870 (0.8%) patients. Short courses of azithromycin are as effective as longer courses of other antibiotics for upper respiratory tract infections. Convenience of dosing should be balanced against the increased cost of this regimen for the treatment of these common infections, where often no antibiotic may be indicated at all.

* Corresponding author. Tel: +1-617-636-7670; Fax: +1-617-636-8023; E-mail: JLaul{at}lifespan.org


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