Clarithromycin Treatment to Prevent Sepsis Progression in CAP (REACT)

Inclusion Criteria: * Age equal to or above 18 years * Male or female gender * In case of women of reproductive age, willingness to use dual contraceptive method during the study period * Written informed consent provided by the patient. For subjects without decision-making capacity, informed consent must be obtained from a legally designated representative following the national legislation * Community-acquired pneumonia (CAP) * Presence of at least two of the following signs: i) cough; ii) purulent sputum expectoration; iii) dyspnea; and/or iv) pleuritic chest pain * PCT ≥0.25 ng/ml * suPAR ≥6 ng/ml Exclusion Criteria: * Age below 18 years * Denial of written informed consent * Any stage IV malignancy * Any do not resuscitate decision * Patients necessitating non-invasive ventilation or mechanical ventilation * Hospitalization in Intensive Care Unit * Infection by SARS-CoV-2 * Oral or IV intake of corticosteroids at a daily dose equal to or greater than 0.4 mg/kg prednisone for a period greater than the last 15 days * Intake of any macrolide for the current episode of CAP under study * Known infection by the human immunodeficiency virus * Any chronic anti-cytokine treatment for more than two months * QTc interval at rest in the ECG ≥500 msec or history of know long QT syndrome * Medical history of allergy to macrolides * Concomitant oral intake of astemizole, cizapride, doperidone, pimozide, terfenadine, midazolam, ranolazine, ergot alkaloids (e.g. ergotamine and dihydroergotamine), lomitapide and colchicine; patients may be enrolled in the trial if they stop these drugs during trial participation. * Medical history of torsades de pointes arrhythmia * Concomitant intake of lovostatin or simvastatin; patients may be enrolled in the trial if they stop these drugs during trial participation. * Concomitant presence of end-stage liver failure and end-stage renal failure. * Severe hypokalemia or severe hypomagnesemia; a patient may be enrolled one any of these electrolyte disturbances are restored. * Any contradictions for macrolide uptake * Pregnancy or lactation. Women of child-bearing potential will be screened by a urine pregnancy test before inclusion in the study * Participation in any other interventional trial within the last 30 days