👆🏻 #AMSsky

The rationale of the RCT was testing the current standard (7d) in the specific setting of Pseudomonas BSIs.

The DURATIONS design is a relevant contribution, but it adds complexity and I wonder if a multi-arm (5?) approach is convenient when testing durations in such a narrow timeframe.

There was a session at ESCMID 2025 on macrolides for CAP and this paper was heavily featured (lead investigator was panelist). Patient population in this trial was much “sicker” than in other studies. I was convinced of their role and benefit, but not for every hospitalized pt (icu only perhaps)

Totally agree. Definitely not for any CAP.

I was also shocked by the mean age (>80y) and Charlson. Probably this was a major driver for the high mortality, beyond the severity of the infection itself — mean CURB65 was 2-3, the setting for recruitment were Internal Medicine wards instead of ICUs…

I have the same concern!
In this RCT, 25% of patients received steroids in both arms.
The subgroup analysis showed benefits independently (and apparently superior) to the use of steroids, but this relevant question was not primarily addressed by the trial
pdf.sciencedirectassets.com/271247/1-s2....

I think REMAP-CAP has ongoing domains to adress this question, hopefully we’ll get new data soon to confirm the hypothesis
🤞🏻 www.remapcap.eu/domains/

I’ve always been skeptical on the antinflammatory role of macrolides too, but ACCESS RCT made me reconsider.
Results seem consistent across all endpoints and subgroups, and biologically plausible 🤔
A post-hoc analysis suggested the effect is independent -maybe superior- to steroids #AMSsky #IDsky