Comparison of Empiric Antibiotic Treatment Regimens for Hospitalized, Non-severe Community-acquired Pneumonia: A
Sidney D Reeves1, Aaron P Hartmann2, Amanda C Tedder2
1Department of Pharmacy, Lt. Col. Luke Weathers Jr. VA Medical Center, Memphis, Tennessee.
Purpose:
Consensus guidelines for hospitalized, non-severe community-acquired pneumonia (CAP) recommend empiric macrolide + β-lactam or respiratory fluoroquinolone monotherapy in patients with no risk factors for resistant organisms. In patients with allergies or contraindications, doxycycline + β-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 + β-lactam, or doxycycline + β-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 + β-lactam, and 2804 received empiric macrolide + β-lactam. Incidence of in-hospital mortality was not observed to be significantly different among empiric regimens (doxycycline + β-lactam group: 1.9% vs macrolide + β-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 + β-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.
Insights
This study found no significant differences in outcomes for hospitalized patients with community-acquired pneumonia (CAP) treated with doxycycline plus beta-lactam, macrolide plus beta-lactam, or fluoroquinolone monotherapy. These guideline-recommended antibiotic regimens appear equally safe and effective for non-severe CAP.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Community-acquired pneumonia (CAP) treatment guidelines recommend specific empiric antibiotic regimens for hospitalized patients.
- These include macrolide plus beta-lactam or respiratory fluoroquinolone monotherapy, with doxycycline plus beta-lactam as an alternative for specific patient groups.
- Understanding comparative outcomes of these guideline-recommended regimens is crucial for optimizing patient care.
Purpose of the Study:
- To compare clinical and safety outcomes among guideline-recommended empiric antibiotic regimens for hospitalized patients with non-severe community-acquired pneumonia (CAP).
- To evaluate the effectiveness and safety of doxycycline plus beta-lactam compared to other standard CAP treatments.
Main Methods:
- Retrospective, multicenter cohort study of 4685 adult patients with CAP.
- Patients received either respiratory fluoroquinolone monotherapy, empiric macrolide plus beta-lactam, or empiric doxycycline plus beta-lactam.
- Exclusion criteria included immunocompromising conditions and need for vasopressors or mechanical ventilation within 48 hours; primary outcome was in-hospital mortality.
Main Results:
- No significant differences in in-hospital mortality were observed among the three empiric regimens (1.9% for doxycycline + beta-lactam, 1.9% for macrolide + beta-lactam, 1.5% for fluoroquinolone monotherapy; P = 0.588).
- Secondary outcomes, including clinical failure, readmission rates, and length of stay, also did not differ significantly between groups.
- Safety outcomes, such as Clostridioides difficile infection and aortic aneurysm rupture, showed no significant variations.
Conclusions:
- The study found no significant differences in clinical or safety outcomes among the three guideline-recommended empiric CAP treatment regimens.
- Empiric doxycycline plus beta-lactam appears to be a safe and effective option for hospitalized patients with non-severe CAP.
- Further research with larger patient cohorts is recommended to confirm these findings.
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