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The University of Louisville Journal of Respiratory Infections

Abstract

Background

Current guidelines recommend a β-lactam plus a macrolide or fluoroquinolone monotherapy as initial empiric antibiotic therapy for treatment of patients hospitalized with community-acquired pneumonia (CAP). Multiple studies have shown different results comparing the two regimens for the treatment of CAP. Our objective, in a city-wide prospective study, was to compare outcomes among hospitalized patients with CAP who received empiric treatment either with a β-lactam plus a macrolide or fluoroquinolone monotherapy.

Methods

This was a propensity score matched case-control study of the University of Louisville Pneumonia Study. It was a prospective population-based cohort study of all hospitalized adults with CAP. Patients were divided into two groups and propensity score matched based on empiric therapy; a β-lactam plus a macrolide compared to fluoroquinolone monotherapy. Study outcomes were time to clinical stability, length of stay, and in-hospital, 30-day and 1-year mortality. Stratified Cox proportional hazards regression was performed to analyze continuous variable differences between groups. Conditional logistic regression was performed to analyze dichotomous variable differences in mortality.

Results

An association was not found between the two groups for time to clinical stability (aHR: 1.06; 95% CI: 0.93-1.22), length of stay (aHR: 1.14; 95% CI: 0.99-1.32) or mortality.

Conclusion

The present study did not show any difference in short or long-term outcomes for hospitalized patients with CAP who were treated with either a β-lactam plus a macrolide or fluoroquinolone monotherapy. Hence, our study does not support the superiority of one treatment over other.

Funder

Division of Infectious Diseases, University of Louisville

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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