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Legionnaires' disease mortality similar for quinolones vs. azithromycin
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There was no difference observed in hospital mortality between azithromycin or quinolone regimens when treating patients with legionnaires’ disease, according to recent findings.
In addition, azithromycin and quinolones yielded similar hospital lengths of stay, rates of Clostridium difficile colitis, and hospital costs, researchers reported in Clinical Infectious Diseases.
“Mortality for Legionella pneumonia patients has steadily improved from 34% in 1980 to 12% in 1998 to 3.1% in 2010,” the researchers wrote. “Yet 20% to 25% of patients require invasive mechanical ventilation and hospital mortality remains 35% in this subset. Evolution of antibiotic strategies for [L. pneumonia] is likely an important driver of improved outcomes.”
The researchers evaluated data on 3,152 adult patients included in the Premier Perspectives drug utilization database from July 2008 through June 2013 in a retrospective cohort study. ICD-9 coding was used to identify adult patients with L. pneumonia, or legionnaires’ disease (LD). Pharmacy charges were used to identify antibiotic choice, dose and duration, along with a propensity score-matching strategy to compare LD patients who received azithromycin vs. quinolone.
A subgroup analysis was conducted on patients with severe LD, defined as: disease requiring ICU admission, requiring mechanical ventilation, or the predicted likelihood of hospital mortality in the top quartile of all LD patients.
Data showed that quinolones alone were used in 28.8% of the patients, azithromycin alone was used in 34%, and both were used in 1.8% of patients. Crude rates for hospital mortality were similar: 6.6% (95% CI, 5%-8.2%) for quinolones vs. 6.4% (95% CI, 5%-7.9%) for azithromycin. Mortality was similar after propensity matching, at 6.3% (95% CI, 4.6%-7.9%) for quinolones compared with 6.5% (95% CI, 4.8%-8.2%) for azithromycin.
In the subgroup analysis, the mortality rates were 14.9% (95% CI, 10%-19.8%) for quinolones vs. 18.3 (95% CI, 13%-23.6%) for azithromycin. No difference was observed in hospital length of stay, development of C. difficile, or hospital cost.
“Consistent with current guidelines, our results support the use of either azithromycin or a quinolone as in-hospital treatment for patients with LD,” the researchers wrote. “Local determinants — such as formulary preference or antimicrobial stewardship programs — may appropriately impact decisions.”
Disclosure: The researchers report no relevant financial disclosures.
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