ArticleCritical care (London, England)2022
Effect of erythromycin on mortality and the host response in critically ill patients with sepsis: a target trial emulation.
Article in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials: A Systematic Review.JAMA network open · 2023Pooled it
- QT Prolongation, Ventricular Arrhythmia, and Cardiac Arrest Signals During Ceftriaxone Co-therapy with Individual Proton Pump Inhibitors: A Multidatabase Study.Cardiovascular toxicology · 2026Observational
- From study design to executable code: automating target trial emulation with large language models.JAMIA open · 2026Article
- Probable sepsis-associated encephalopathy as a component of multiple organ dysfunction syndrome in a cat with pyothorax.Australian veterinary journal · 2026Article
- Design and Implementation of Observational Studies Emulating a Target Trial.JAMA network open · 2026Article
- A comprehensive landscape of AI applications in broad-spectrum drug interaction prediction: a systematic review.Journal of cheminformatics · 2025Review
- Macrolide Therapy in Patients with Sepsis or Septic Shock: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2025Review
- The Interplay between Antibiotics and the Host Immune Response in Sepsis: From Basic Mechanisms to Clinical Considerations: A Comprehensive Narrative Review.Antibiotics (Basel, Switzerland) · 2024Review
- No evidence for relevant impact of renal replacement therapy on clinical effect of erythromycin in critically ill patients with sepsis.Critical care (London, England) · 2023Article
- Study claiming target in sepsis with erythromycin has no effect upon mortality and secondary outcomes includes patients with CRRT and RRT.Critical care (London, England) · 2023Article
- Histamine H2 receptor antagonist exhibited comparable all-cause mortality-decreasing effect as β-blockers in critically ill patients with heart failure: a cohort study.Frontiers in pharmacology · 2023Article
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Authors and funding
10 authors at 4 institutions in 4 countries.
Funding
Abstract
backgroundImmunomodulatory therapies that improve the outcome of sepsis are not available. We sought to determine whether treatment of critically ill patients with sepsis with low-dose erythromycin-a macrolide antibiotic with broad immunomodulatory effects-decreased mortality and ameliorated underlying disease pathophysiology.
methodsWe conducted a target trial emulation, comparing patients with sepsis admitted to two intensive care units (ICU) in the Netherlands for at least 72 h, who were either exposed or not exposed during this period to treatment with low-dose erythromycin (up to 600 mg per day, administered as a prokinetic agent) but no other macrolides. We used two common propensity score methods (matching and inverse probability of treatment weighting) to deal with confounding by indication and subsequently used Cox regression models to estimate the treatment effect on the primary outcome of mortality rate up to day 90. Secondary clinical outcomes included change in SOFA, duration of mechanical ventilation and the incidence of ICU-acquired infections. We used linear mixed models to assess differences in 15 host response biomarkers reflective of key pathophysiological processes from admission to day 4.
resultsIn total, 235 patients started low-dose erythromycin treatment, 470 patients served as controls. Treatment started at a median of 38 [IQR 25-52] hours after ICU admission for a median of 5 [IQR 3-8] total doses in the first course. Matching and weighting resulted in populations well balanced for proposed confounders. We found no differences between patients treated with low-dose erythromycin and control subjects in mortality rate up to day 90: matching HR 0.89 (95% CI 0.64-1.24), weighting HR 0.95 (95% CI 0.66-1.36). There were no differences in secondary clinical outcomes. The change in host response biomarker levels from admission to day 4 was similar between erythromycin-treated and control subjects.
conclusionIn this target trial emulation in critically ill patients with sepsis, we could not demonstrate an effect of treatment with low-dose erythromycin on mortality, secondary clinical outcomes or host response biomarkers.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.