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Effectiveness of combination therapy versus monotherapy with a third-generation cephalosporin in bacteraemic

C De la Calle1, H G Ternavasio-de la Vega2, L Morata1

  • 1Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain.

The Journal of Infection
|January 24, 2018
PubMed
Abstract

Insights

Combination antibiotic therapy for bacteraemic pneumococcal pneumonia, using a macrolide or fluoroquinolone with a cephalosporin, significantly reduces 30-day mortality compared to monotherapy. This supports current treatment guidelines for severe pneumonia.

Area of Science:

  • Infectious Diseases
  • Bacteriology
  • Pharmacology

Background:

  • International guidelines recommend combining macrolides or fluoroquinolones with beta-lactams for moderate to severe community-acquired pneumonia.
  • Limited data exists on combination therapy specifically for bacteraemic pneumococcal pneumonia.

Purpose of the Study:

  • To evaluate the impact of empirical antibiotic therapy on mortality in patients with bacteraemic pneumococcal pneumonia.
  • To compare the outcomes of monotherapy versus combination therapy (cephalosporin plus macrolide or fluoroquinolone).

Main Methods:

  • Propensity score analysis of prospectively collected data from 2000-2015.
  • Inclusion of patients with bacteraemic pneumococcal pneumonia treated with third-generation cephalosporin monotherapy or combination therapy.
  • Comparison of 30-day mortality between monotherapy (n=69) and combination (n=314) groups after propensity score adjustment.

Main Results:

  • Monotherapy was associated with significantly higher 30-day mortality (OR 2.89) after propensity score adjustment.
  • Higher mortality in the monotherapy group was observed in both 1:1 and 1:2 matched samples, statistically significant in the 1:2 sample (OR 3.50).

Conclusions:

  • Empirical combination therapy (third-generation cephalosporin plus macrolide or fluoroquinolone) is associated with lower mortality in bacteraemic pneumococcal pneumonia compared to monotherapy.
  • These findings support the use of combination therapy for hospitalized patients with moderate to severe disease.
Keywords:
BacteraemiaCombination therapyMortalityPneumococcal pneumoniaPropensity score

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