Determinants, outcomes and costs of ceftriaxone v. amoxicillin-clavulanate in the treatment of community-acquired pneumonia at Witbank Hospital

Abstract

Background. Community-acquired pneumonia (CAP) is a major cause of death and morbidity worldwide. Treatment is centred on antibiotics with ceftriaxone and amoxicillin-clavulanate being some of the most commonly prescribed agents. Objective. To compare treatment outcomes and costs in patients receiving either of these two antibiotics at Witbank Hospital (WH). Methods. A total of 200 randomly selected adult patient files (100 receiving ceftriaxone and 100 amoxicillin-clavulanate) recording a diagnosis of CAP were studied to determine the length of hospital stay, comorbid conditions and treatment outcomes. A descriptive and comparable analysis was performed. Results. Male gender, higher CURB-65 scores and death were associated with the use of ceftriaxone. Severity of disease and previous antibiotic exposure influenced the duration of hospital admission. Conclusion. Gender and severity of disease (based on the CURB-65 score) were the determinants of antibiotic choice at WH. Male gender increased the likelihood of being treated with ceftriaxone, as did a CURB-65 score of >2. There were no differences in the outcomes of CAP patients treated with ceftriaxone compared with those treated with amoxicillin-clavulanate. Irrespective of antibiotic used, gender and severity of disease influenced treatment outcomes. Male gender was associated with a higher mortality and longer hospital stay. The average duration of stay for both antibiotics was not significantly different. Thus, only level 1 and 2 costs need to be considered when comparing the two regimens. On this basis, ceftriaxone was cheaper than amoxicillin-clavulanate.

Comparison between Ceftriaxone and Sulbactam-Ampicillin as Initial Treatment of Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis

“…The clinical cure rate also showed no significant difference between the two antibiotics. In addition, no significant difference was found between ceftriaxone and β-lactam/β-lactamase inhibitor combinations in the treatment of CAP [ 23 , 24 ], which is consistent with our findings. Preliminary meta-analysis with limited data shows no difference in clinical effectiveness.…”

Comparison of ceftriaxone plus macrolide and ampicillin/sulbactam plus macrolide in treatment for patients with community-acquired pneumonia without risk factors for aspiration: an open-label, quasi-randomized, controlled trial

“…A similar result was obtained on days 4 and 7 in the MITT population (p = 0.018, 0.007). It has been reported that there is no significant difference between β-lactam/β-lactamase inhibitor combinations and third-generation cephalosporins in the treatment of CAP [13][14][15][16]. However, most of those previous reports were retrospective studies, except for one that, unfortunately, did not undertake a direct comparison between β-lactam/β-lactamase inhibitor combinations and third-generation cephalosporins.…”

“…The following clinical data were evaluated on admission: vital signs, comorbidities, physical examination findings, prior antibiotic treatment, and allergy to antibiotics. To evaluate the effects of treatment, clinical findings, chest radiography findings, and laboratory test results were collected before, during, and at end of treatment (EOT; days [7][8][9][10][11][12][13][14]. The late response to treatment was evaluated at end of study (EOS; days [28][29][30][31][32][33][34][35].…”

“…Because the susceptibility of anaerobic bacteria to CTRX is relatively low [11,12], some guidelines recommend ABPC/SBT for the treatment of aspiration pneumonia [3,4]. In previous reports that did not consider aspiration risks, no significant differences were found between CTRX and β-lactam/β-lactamase inhibitor combinations such as ABPC/SBT for the treatment of pneumonia [13][14][15][16]. Only one paper has compared ABPC/SBT with CTRX in the treatment of aspiration pneumonia patients [17].…”