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Beta-lactam performs similarly to preferred treatments for CAP
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Patients with community-acquired pneumonia had similar outcomes when randomized to one of three antibiotic treatment therapies, with regard to 90-day mortality, according to a recently published study in the New England Journal of Medicine.
To assess the efficacy of various treatments, researchers randomized patients who were admitted to non-ICU wards with community-acquired pneumonia (CAP) to receive either beta-lactam (n = 656), beta-lactam plus macrolide (n = 739) or fluoroquinolone (n = 888).
Results demonstrated that the crude 90-day mortality was 9% for beta-lactam treatment, 11.1% for beta-lactam plus macrolide treatment and 8.8% for fluoroquinolone treatment.
Risk of death was 1.9 percentage points higher (90% CI; – 0.6-4.4) with beta-lactam plus macrolide treatment than with the beta-lactam treatment. Risk of death was 0.6 percentage points (90% CI; – 2.8-1.9) lower when using fluoroquinolone treatment than with the beta-lactam treatment.
Overall, length of hospital stay was similar among all treatment strategies, with a median length of 6 days.
“The noninferiority of the beta-lactam strategy to the beta-lactam–macrolide strategy was apparent in all analyses. These findings, together with the slightly longer length of hospital stay with the latter strategy, reported associations with the development of resistance and possible increased risks of cardiac events, indicate that the addition of macrolides for empirical treatment of CAP should be reconsidered,” Cornelis H. van Werkhoven, MD, Julius Center for Health Sciences and Primary Care at University Medical Center Utrecht, and colleagues wrote. – by Casey Hower
Disclosure: The researchers report no relevant financial disclosures.
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