Azithromycin plus β-lactam versus levofloxacin plus β-lactam for severe community-acquired pneumonia: A retrospective...

Area of Science:

• Infectious Diseases
• Pulmonology
• Clinical Pharmacology

Background:

• Severe community-acquired pneumonia (CAP) treatment often involves combination antibiotic therapy.
• Previous research suggested potential benefits of macrolides combined with β-lactams for severe CAP.
• Comparative effectiveness of macrolide-plus-β-lactam versus fluoroquinolone-plus-β-lactam regimens for severe CAP remains unclear.

Purpose of the Study:

• To compare the 28-day and in-hospital mortality rates between azithromycin plus β-lactam and levofloxacin plus β-lactam regimens in severe CAP patients.
• To evaluate the efficacy of two distinct antibiotic combination strategies for treating severe CAP.

Main Methods:

• Retrospective analysis of a nationwide inpatient database in Japan (July 2010–March 2015).
• Inclusion of 1,999 severe CAP patients treated with either azithromycin plus β-lactam or levofloxacin plus β-lactam within 2 days of admission.
• Application of propensity score matching (560 pairs) and inverse probability of treatment weighting (IPTW) for comparative analysis.

Main Results:

• Propensity score matching revealed no significant difference in 28-day mortality (19.3% vs. 20.7%, p=0.601) or in-hospital mortality (24.8% vs. 26.8%, p=0.495) between the two groups.
• IPTW analysis confirmed no significant differences in 28-day mortality (risk difference, -3.5%; 95% CI, -8.8% to 1.7%) or in-hospital mortality (risk difference, -3.6%; 95% CI, -9.4% to 2.1%).

Conclusions:

• Azithromycin plus β-lactam and levofloxacin plus β-lactam demonstrate comparable 28-day and in-hospital mortality outcomes for severe CAP patients.
• Neither antibiotic combination strategy showed superiority in reducing mortality in this patient population.
• Findings suggest that treatment choice between these regimens for severe CAP may not significantly impact short-term mortality.