Publication:

Clinico-epidemiological evaLuation of mAcrolide use In Respiratory tract infections (CLAIR): a retrospective study

Background Respiratory tract infections (RTIs) are frequently seen in clinical practice, and macrolides are widely used for their management in India. However, real-world evidence (RWE) on prescribing patterns and clinical outcomes with macrolide use in RTIs is still limited. This study evaluated utilization patterns and effectiveness of macrolides for RTIs using an electronic medical records (EMR) database.

Methods This retrospective, observational, EMR-based study analysed anonymized HealthPlix EMR data from January 2017 to June 2025. Adult patients (≥18 years) prescribed erythromycin, roxithromycin, azithromycin, or clarithromycin with a documented follow-up within 20 days were included. Propensity score matching (PSM) was applied for comparative effectiveness analysis between azithromycin and clarithromycin.

Results A total of 78,499 eligible RTI patients were analyzed. Azithromycin (N=64,638) and clarithromycin (N=12,448) were the most frequently prescribed macrolides. Most patients were aged <60 years. Across macrolides, fever, cold, and cough predominated in upper RTIs (URTIs) whereas cough and dyspnea in lower RTIs (LRTIs), with bronchitis being the most common LRTI diagnosis. Hypertension and diabetes mellitus were the most common comorbidities. A 5–7-day regimen predominated across macrolides. Following PSM (12,448 patients per cohort of azithromycin and clarithromycin), overall symptom resolution was significantly higher with clarithromycin than azithromycin (72.36% vs 64.33%; p<0.001), with similar findings in URTI (74.98% vs 61.15%) and LRTI (69.86% vs 67.36%) subgroups. Symptom resolution remained high after switching to clarithromycin from other antibiotics.

Conclusions This study provides RWE on macrolide prescribing patterns in RTIs and demonstrates higher symptom resolution with clarithromycin than azithromycin in routine clinical practice.