Macrolides still look good for pneumonia

Cochranized in the past, macrolides (usually azithromycin) seem more convincingly beneficial regarding mortality and treatment failure in pneumonia (especially in the elderly). This large but retrospective VA registry analysis supports this suggestion. The finding of more MIs but fewer ‘cardiac events’ is confusing. First line for everyone, include it in the initial antimicrobials, continue it despite negative atypical screen, avoid in ischaemic heart disease – I don’t think we know yet.