Antimicrobial Options Assessed for Community-Acquired Pneumonia

<i>Streptococcus pneumoniae</i> bacteria grown from a blood culture. <i>Photo Credit: CDC/Dr. Mike Miller.</i>
Streptococcus pneumoniae bacteria grown from a blood culture. Photo Credit: CDC/Dr. Mike Miller.

Findings from a US claims-based retrospective study published in Hospital Practice call for the development of more effective antimicrobial treatments that have a reduced adverse events burden for patients with community-acquired pneumonia (CAP). 

Currently available treatment options for CAP often carry the potential for treatment failure and safety risk. Researchers aimed to evaluate real-world outcome associated with currently available antimicrobial options in both inpatient (non-intensive care unit [ICU]) and outpatient settings.

The study included adults diagnosed with CAP treated with any oral fluoroquinolone, macrolide, or beta-lactam monotherapy in the outpatient setting, and intravenous (IV) levofloxacin or IV azithromycin/ceftriaxone in the inpatient setting. A total of 441,820 outpatients and 33,287 inpatients treated for CAP between 2007 - 2012 were included in the analysis. 

Study authors found that in the outpatient setting, fluoroquinolone therapy resulted in a higher rate of documented adverse events (adjusted odds ratio [OR] 1.23; 95% CI, 1.20-1.25; <.0001) but a lower rate of retreatment (adjusted OR 0.9; 95% CI, 0.87–0.94; <.0001) compared with macrolides. For these patients, adverse events and retreatment were tied to higher costs. 

Patients treated with IV macrolide/beta-lactam combination vs IV fluoroquinolone in the inpatient setting experienced a significantly longer length of stay in the hospital (4.71 vs 4.38; <.0001) and higher overall costs ($3,535 more per stay; <.0001). 

Researchers concluded that new effective treatment options with a decreased adverse event profile for patients with CAP are needed in both the inpatient and outpatient settings. 

Reference

Llop CJ, Tuttle E, Tillotson GS, LaPlante K, File TM Jr. Antibiotic treatment patterns, costs, and resource utilization among patients with community acquired pneumonia: a US cohort study. Hosp Pract. 2017:1-8. doi: 10.1080/21548331.2017.1279012

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