Chest

Antibiotic regimens for community-acquired pneumonia compared

September 27, 2023

Among non-critically ill patients hospitalized with community-acquired pneumonia (CAP), three antibiotic regimens had similar outcomes and can be considered effective.

• This retrospective cohort study included consecutive CAP patients admitted to 19 Canadian hospitals between 2015 and 2021. Patients were categorized into four antibiotic groups based on initial antibiotic treatment within 48 hours of admission. Those with severe CAP, requiring ICU admission in the first 48 hours, were excluded.
• Of 23,512 patients, 9,340 (39.7%) received β-lactam plus macrolide (BL+M), 9,146 (38.9%) received BL alone, 4,510 (19.2%) received a respiratory fluoroquinolone (FQ), and 516 (2.2%) received BL+doxycycline (BL+D). In-hospital mortality rates were as follows: 7.5% in the BL+M group, 9.7% in the BL group, 6.7% in the FQ group, and 6.0% for the BL+D group. Adjusted risk difference for in-hospital mortality when compared with BL+M was 1.5% (95% confidence interval [CI], -0.3%-3.3%) for BL, -0.9% (95% CI, -2.9% to 1.1%) for FQ, and -1.9% (95% CI, -4.8% to 0.9%) for BL+D. Compared with BL+M, the subdistribution hazard ratio for being discharged alive was 0.90 (95% CI, 0.84-0.96) for BL, 1.07 (95% CI, 0.99-1.16) for FQ, and 1.04 (95% CI, 0.93-1.17) for BL+D.
• Authors conclude that BL+M, FQ, and BL+D had similar outcomes and can be considered effective regimens for non-severe CAP. Compared with BL+M, BL alone was associated with longer hospital stay and the confidence interval for mortality can’t exclude a small but clinically important increase in risk.

Source:

Bai AD, et al. (2023, August 10). Chest. Comparative Effectiveness of First-Line and Alternative Antibiotic Regimens in Hospitalized Patients With Nonsevere Community-Acquired Pneumonia: A Multicenter Retrospective Cohort Study. https://pubmed.ncbi.nlm.nih.gov/37574164/