Objective: The objective of this systematically review is to compare efficacy of azithromycin and clarithromycin in combination with b-lactams in the treatment of community acquired pneumonia among hospitalized adults.

Results: A total of 7 clinical trials were included in the qualitative evidence synthesis. An average of 87.55% for azithromycin-b-lactam at day 10-14 and 75.42% for clarithromycin-b-lactam at day 5-7 of therapy, was identified. Streptococcus pneumonia was commonly found in both macrolides’ groups with 130 isolates in clarithromycin-based combination and 80 isolates in azithromycin-based group. An average mean day in length of hospital stay of 8.45 days was found in patients receiving b-lactams with azithromycin combination and 7.25 days with clarithromycin combination.

Conclusion: The review reported macrolide inter-class differences, with higher clinical success rate reported with azithromycin-based combination. However, shorter length of hospital stay is achieved with clarithromycin-beta-lactam regimen. Hence, the choice of the macrolide to be combined with a b-lactam should be guided with susceptibility data of the treating facility.