Antibiotic Regimen Strategy for Improving Severe Community-Acquired Pneumonia

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Mortality was significantly lower when combination therapy included a β-lactam and a macrolide.
Mortality was significantly lower when combination therapy included a β-lactam and a macrolide.

In patients with community-acquired pneumonia, a combination antibiotic regimen with a macrolide was shown to improve short- and long-term outcomes, according to recent research published in the Journal of Critical Care.

In a post hoc analysis of 502 adults with community-acquired pneumonia from the Infection on Admission to the ICU (INFAUCI) study, researchers evaluated the association of antibiotic therapy regimens with mortality and length of hospital stay. The appropriateness of the antibiotic regimen was also determined based on microbiologic phenotypes and evidence of sensitivity to the prescribed antibiotics.

Combination antibiotic therapy with a macrolide was associated with decreased in-hospital mortality at the hospital (odds ratio [OR] 0.17, 95% CI 0.06-0.51) and decreased 6-month mortality (OR 0.21, 95% CI 0.07-0.57). No significant effect on length of hospital stay was driven by selection of antibiotic therapy.  

Antibiotic therapy for more than 7 days was associated with a longer ICU and hospital stay (P <.001 for both), but had no beneficial effect on mortality (P =.39).

In patients who had documented microorganisms (n=177), 16% received inappropriate antibiotic therapy, indicating that the identified pathogens did not have in vitro sensitivity to any of the prescribed antibiotics.

Most patients were treated with combination antibiotic therapy (76%; n=381), and 80% (n=305) of those patients received a β-lactam with a macrolide (80%; n=305).

The study investigators concluded that in patients who have community-acquired pneumonia, "the only antibiotic strategy that seems to improve significantly both hospital and 6 months mortality is the use of combination of antibiotics that includes a macrolide."

Reference

Pereira JM, Gonçalves-Pereira J, Ribeiro O, Baptista JP, Froes F, Paiva JA. Impact of antibiotic therapy in severe community-acquired pneumonia: data from the Infauci study. J Crit Care. 2017;43:183-189. 

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