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Guideline adherence and macrolides reduced mortality in outpatients with pneumonia

Leyla Asadi1, Dean T Eurich, John-Michael Gamble

  • 1Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Respiratory Medicine
|December 21, 2011
PubMed
Abstract

Insights

Guideline-concordant antibiotics, including macrolides, significantly reduced 30-day mortality in outpatient pneumonia patients. Adhering to treatment guidelines improves survival rates for community-acquired pneumonia.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Public Health

Background:

  • Pneumonia treatment guidelines recommend empiric antibiotics for outpatients.
  • Macrolides are often suggested as preferred antibiotic agents.
  • This study investigated the association between guideline-concordant antibiotics and macrolides with mortality in pneumonia patients.

Purpose of the Study:

  • To determine if guideline-concordant antibiotic therapy reduces mortality in outpatients with pneumonia.
  • To assess if macrolide antibiotics are associated with reduced mortality compared to other agents within guideline-concordant regimens.

Main Methods:

  • A population-based registry of 2973 outpatients with pneumonia was established across 7 Emergency Departments.
  • Data collected included clinical-radiographic information, Pneumonia Severity Index (PSI) scores, and treatments received.
  • Guideline-concordant regimens included macrolides and respiratory fluoroquinolones; the primary outcome was 30-day all-cause mortality.

Main Results:

  • Most patients (96%) received guideline-concordant antibiotics.
  • Guideline-concordant antibiotics were associated with significantly lower 30-day mortality compared to discordant regimens (aOR 0.23).
  • Within the guideline-concordant group, macrolides were associated with reduced mortality compared to fluoroquinolones (aOR 0.28).

Conclusions:

  • Treatment with guideline-concordant antibiotics is associated with reduced mortality in outpatients with pneumonia.
  • The use of macrolides as part of guideline-concordant therapy further correlates with decreased mortality rates.

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