Comparison of Empiric Antibiotic Treatment Regimens for Hospitalized, Non-severe Community-acquired Pneumonia: A Retrospective, Multicenter Cohort Study

被引:1
作者
Reeves, Sidney D. [1 ]
Hartmann, Aaron P. [2 ]
Tedder, Amanda C. [2 ]
Juang, Paul A. [3 ]
Hofer, Mikaela [4 ]
Kollef, Marin H. [5 ]
Micek, Scott T. [3 ,6 ]
Betthauser, Kevin D. [2 ]
机构
[1] Lt Col Luke Weathers Jr VA Med Ctr, Dept Pharm, Memphis, TN USA
[2] Barnes Jewish Hosp, Dept Pharm Practice, St Louis, MO USA
[3] Univ Hlth Sci & Pharm, Dept Pharm Practice, St Louis, MO USA
[4] Mayo Clin Rochester, Dept Pharm, Rochester, MN USA
[5] Washington Univ, Sch Med, Div Pulm & Crit Care Med, St Louis, MO USA
[6] Univ Hlth Sci & Pharm, Ctr Hlth Outcomes Res & Educ, St Louis, MO USA
关键词
Antibiotics; Doxycycline; Community-acquired pneumonia; Outcomes; COMBINATION THERAPY; TREATMENT FAILURE; DOXYCYCLINE; MORTALITY; MACROLIDES; IMPACT;
D O I
10.1016/j.clinthera.2024.01.009
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Purpose: Consensus guidelines for hospitalized, non-severe community-acquired pneumonia (CAP) recommend empiric macrolide + p-lactam or respiratory fluoroquinolone monotherapy in patients with no risk factors for resistant organisms. In patients with allergies or contraindications, doxycycline + p-lactam is a recommended alternative. The purpose of this study was to compare differences in outcomes among guideline-recommended regimens in this population. Methods: This retrospective, multicenter cohort study included patients >= 18 years of age with CAP who received respiratory fluoroquinolone monotherapy, empiric macrolide + p-lactam, or doxycycline + p-lactam. Major exclusion criteria included patients with immunocompromising conditions, requiring vasopressors or invasive mechanical ventilation within 48 hours of admission, and receiving less than 2 days of total antibiotic therapy. The primary outcome was in-hospital mortality. Secondary outcomes included clinical failure, 14- and 30-day hospital readmission, and hospital length of stay. Safety outcomes included incidence of new Clostridioides difficile infection and aortic aneurysm ruptures. Findings: Of 4685 included patients, 1722 patients received empiric respiratory fluoroquinolone monotherapy, 159 received empiric doxycycline + p-lactam, and 2804 received empiric macrolide + p-lactam. Incidence of in- hospital mortality was not observed to be significantly different among empiric regimens (doxycycline + p-lactam group: 1.9% vs macrolide + p-lactam: 1.9% vs respiratory fluoroquinolone monotherapy: 1.5%, P = 0.588). No secondary outcomes were observed to differ significantly among groups. Implications: We observed no differences in clinical or safety outcomes among three guideline-recommended empiric CAP regimens. Empiric doxycycline + p-lactam may be a safe empiric regimen for hospitalized CAP patients with non-severe CAP, although additional research is needed to corroborate these observations with larger samples.
引用
收藏
页码:338 / 344
页数:7
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