antibiotic treatment strategies for community acquired pneumonia in adults

8/17/2019 antibiotic treatment strategies for community acquired pneumonia in adults

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ac/ground

Community-Acquired Pneumonia 0CAP1 is a leadingcause of $ositalization and deat$ 2orl2ide

3or atients 2it$ clinically susected CAP 2$o areadmitted to a non4intensi5e-care-unit 0%C61 2ard!guidelines recommend :

combination t$eray 2it$ a beta-lactam lus amacrolide or lus ciro7o8acin! or

monot$eray 2it$ mo8i7o8acin or le5o7o8acin foremirical treatment

increased t$e use of macrolides and 7uoroquinolones! alt$oug$t$ese antibiotic classes $a5e been associated 2it$ increased

de5eloment of resistance.


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ac/ground 091

Alt$oug$ 7uoroquinolones $a5e been e5aluated inrandomized! controlled trials! t$eir sueriority o5erbetalactam monot$eray $as not been s$o2n.

e t$erefore assessed 2$et$er a strategy ofreferred emirical treatment 2it$ beta-lactammonot$eray is noninferior to eit$er referred beta-

lactam4macrolide combination t$eray or referred7uoroquinolone monot$eray! 2it$ regard to ;(-dayall-cause mortality among adults 2it$ clinicallysusected CAP 2$o are admitted to non-%C6 2ards


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"et$ods

e erformed a ragmatic! cluster-randomized!crosso5er trial to o5ercome confounding by indicationand t$e e


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&esults

EnrollmentA total of ??9* atients 2ere eligible for inclusion in t$estudy! and 99=? 0);@1 ga5e consent. T$e median age oft$e atients 2as +( years 0interquartile range! *; to +;1.

T$e baseline c$aracteristics of included atients 2eresimilar among strategy eriods! and blood and sutumcultures and urinary antigen testing for Stretococcusneumoniae and egionella neumo$ila 2ereerformed 2it$ similar frequency

T$e microbial causes of CAP 2ere similar in t$e t$reetreatment grous. S. neumoniae 2as t$e at$ogendetected most frequently 0in '*.;@ of atients1! follo2edby aemo$ilus in7uenzae 0in ).=@1B atyical at$ogens2ere found in 9.'@ of t$e atients


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Primary #utcomes

T$e absolute di


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Secondary #utcomes

T$e median lengt$ of $osital stay 2as ) days for allstrategies! but t$e uer quartile 2as $ig$er during t$ebeta-lactam4macrolide strategy eriods

T$e median duration of intra5enous treatment 2as ? daysduring t$e 7uoroquinolone strategy eriods and > daysduring t$e ot$er strategy eriods

T$e roortions of atients 2$ose treatment started 2it$oral antibiotics 2ere 9+@ during t$e 7uoroquinolone

strategy eriods! as comared 2it$ '?@ and '(@ during t$ebeta-lactam and beta-lactam4macrolide strategy eriods!resecti5ely. T$ere 2ere no signicant di


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Discussion

%n t$is ragmatic! cluster-randomized! crosso5ertrial! a strategy of referred emirical treatment2it$ beta-lactam monot$eray 2as noninferior to

strategies of treatment 2it$ beta-lactam4macrolidecombination t$eray and 2it$ 7uoroquinolonemonot$eray among atients 2it$ susect CAP2$o 2ere admitted to non-%C6 2ards


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Discussion

%n conclusion! among atients 2it$ susected CAP2$o 2ere admitted to non-%C6 2ards! 2e foundt$at a strategy of referred emirical treatment

2it$ beta-lactam monot$eray t$at allo2ed forde5iations for medical reasons 2as noninferior tostrategies 2it$ beta-lactam4macrolide combinationt$eray or 7uoroquinolone monot$eray in termsof ;(-day all-cause mortality

%n addition! beta-lactam monot$eray 2as notassociated 2it$ a longer lengt$ of $osital stay ora $ig$er incidence of comlications


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Thank You

antibiotic treatment strategies for community acquired pneumonia in adults

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