Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database - PubMed (original) (raw)
Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database
Richard B Brown et al. Chest. 2003 May.
Abstract
Background: Much controversy exists regarding the initial choice of antibiotics and selected outcomes for patients with community-acquired pneumonia (CAP).
Methods: The investigators analyzed a hospital claims-made database to assess the impact of initial antibiotic choice on 30-day mortality, total hospital costs, and hospital length of stay (LOS). Fine risk groups allowed for stratification for variations in the severity of illness. Patients were divided into five monotherapy groups (ie, ceftriaxone, "other" cephalosporins, fluoroquinolones, macrolides, or penicillins) and four groups that received dual therapy (ie, the agents listed above, except macrolides) plus macrolides. Patients also were stratified by age (ie, > 65 years of age and < 65 years of age). Severely ill patients were excluded.
Results: Overall, 44,814 persons met the criteria for inclusion. Among monotherapy patients, those who received macrolides had the least mortality but were the least ill. Patients who received dual therapy generally had shorter LOSs, lower total hospital charges, and decreased mortality compared with those who received monotherapy. Differences among dual-therapy regimens regarding outcomes studies were noted. Patients who were < 65 years of age had lower mortality rates, shorter LOSs, and lower hospital charges than did the more elderly patients. Within this group, those who received dual therapy had better outcomes than those who received monotherapy.
Conclusions: We confirmed the value of dual therapy employing macrolides as a second agent in decreasing mortality from CAP, and we provided similar data regarding shorter LOSs and lower hospital charges. This appears to hold for a younger population. Differences among dual-therapy regimens (all employing macrolides) appear to exist and may be clinically relevant.
Comment in
- Combination antibiotic therapy with macrolides in community-acquired pneumonia: more smoke but is there any fire?
Waterer GW. Waterer GW. Chest. 2003 May;123(5):1328-9. doi: 10.1378/chest.123.5.1328. Chest. 2003. PMID: 12740239 No abstract available. - Evaluating combination therapy in community-acquired pneumonia.
Powers JH, Cooper CK. Powers JH, et al. Chest. 2004 Jan;125(1):353. doi: 10.1378/chest.125.1.353. Chest. 2004. PMID: 14718472 No abstract available.
Similar articles
- Cost-effectiveness of gatifloxacin vs ceftriaxone with a macrolide for the treatment of community-acquired pneumonia.
Dresser LD, Niederman MS, Paladino JA. Dresser LD, et al. Chest. 2001 May;119(5):1439-48. doi: 10.1378/chest.119.5.1439. Chest. 2001. PMID: 11348951 Clinical Trial. - Effect of macrolides as part of initial empiric therapy on length of stay in patients hospitalized with community-acquired pneumonia.
Stahl JE, Barza M, DesJardin J, Martin R, Eckman MH. Stahl JE, et al. Arch Intern Med. 1999 Nov 22;159(21):2576-80. doi: 10.1001/archinte.159.21.2576. Arch Intern Med. 1999. PMID: 10573047 - The efficacy of an antibiotic protocol for community-acquired pneumonia.
Dobbin CJ, Duggan CJ, Barnes DJ. Dobbin CJ, et al. Med J Aust. 2001 Apr 2;174(7):333-7. doi: 10.5694/j.1326-5377.2001.tb143307.x. Med J Aust. 2001. PMID: 11346105 - Health economics of use fluoroquinolones to treat patients with community-acquired pneumonia.
Restrepo MI, Frei CR. Restrepo MI, et al. Am J Med. 2010 Apr;123(4 Suppl):S39-46. doi: 10.1016/j.amjmed.2010.02.005. Am J Med. 2010. PMID: 20350634 Review. - The dilemma of monotherapy or combination therapy in community-acquired pneumonia.
Vardakas KZ, Trigkidis KK, Apiranthiti KN, Falagas ME. Vardakas KZ, et al. Eur J Clin Invest. 2017 Dec;47(12). doi: 10.1111/eci.12845. Epub 2017 Nov 9. Eur J Clin Invest. 2017. PMID: 29027205 Review.
Cited by
- Macrolide-based regimens in absence of bacterial co-infection in critically ill H1N1 patients with primary viral pneumonia.
Martín-Loeches I, Bermejo-Martin JF, Vallés J, Granada R, Vidaur L, Vergara-Serrano JC, Martín M, Figueira JC, Sirvent JM, Blanquer J, Suarez D, Artigas A, Torres A, Diaz E, Rodriguez A; SEMICYUC/REIPI/CIBERES H1N1 Working Group. Martín-Loeches I, et al. Intensive Care Med. 2013 Apr;39(4):693-702. doi: 10.1007/s00134-013-2829-8. Epub 2013 Jan 24. Intensive Care Med. 2013. PMID: 23344833 Free PMC article. - Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia.
Lee MS, Oh JY, Kang CI, Kim ES, Park S, Rhee CK, Jung JY, Jo KW, Heo EY, Park DA, Suh GY, Kiem S. Lee MS, et al. Infect Chemother. 2018 Jun;50(2):160-198. doi: 10.3947/ic.2018.50.2.160. Infect Chemother. 2018. PMID: 29968985 Free PMC article. Review. - Optimal antibiotic treatment in severe pneumococcal pneumonia--time for real answers.
Waterer GW. Waterer GW. Eur J Clin Microbiol Infect Dis. 2005 Oct;24(10):691-2. doi: 10.1007/s10096-005-0019-5. Eur J Clin Microbiol Infect Dis. 2005. PMID: 16244854 No abstract available. - Combination antibiotic therapy for community-acquired pneumonia.
Caballero J, Rello J. Caballero J, et al. Ann Intensive Care. 2011 Nov 23;1:48. doi: 10.1186/2110-5820-1-48. Ann Intensive Care. 2011. PMID: 22113077 Free PMC article. - Symmetrical Gangrene in Both Lower Limbs in Pneumococcal Pneumonia.
Mahto SK, Balakrishna AM, Aggarwal N, Goel A. Mahto SK, et al. Indian J Crit Care Med. 2018 Mar;22(3):200-201. doi: 10.4103/ijccm.IJCCM_530_17. Indian J Crit Care Med. 2018. PMID: 29657383 Free PMC article. No abstract available.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous