Effect of β-Lactam Plus Macrolide Versus Fluoroquinolone on 30-Day Readmissions for Community-Acquired Pneumonia

Abstract

Background: Antibiotic therapy with a macrolide and β-lactam or a fluoroquinolone for the empirical treatment of community-acquired pneumonia (CAP) in an inpatient non–intensive care setting is recommended per guidelines. Studies show that these treatments have similar outcomes, including death, adverse effects, and bacterial eradication. However, a comparison of 30-day readmission rates between these treatments is limited. Study Question: To determine whether 30-day readmissions for patients treated for CAP in a regional hospital differed between a fluoroquinolone monotherapy and a β-lactam plus macrolide combination therapy. Study Design: Retrospective cohort study of patients aged ≥18 years with a CAP diagnosis who were admitted to the same regional hospital from December 1, 2011, through December 1, 2016. Measures and Outcomes: Patients receiving a third-generation cephalosporin plus macrolide were compared with those receiving a respiratory fluoroquinolone. Exclusion criteria were concurrent or recent use of the study antibiotics; death, transfer, or transition to hospice; and diagnosis of hospital-acquired pneumonia or health care–associated pneumonia. The collected data were 30-day readmission rates, antibiotic regimens, demographic characteristics, and pneumonia severity index and comorbidity scores. Association between treatment group and readmissions was assessed with logistic regression. Association between readmissions and individual data points between the 2 treatment groups was calculated with multivariate regression and odds ratio (95% confidence interval). Results: Of 432 patients, 171 met inclusion criteria (fluoroquinolone group, n = 101; β-lactam plus macrolide group, n = 70). Thirty-day readmissions were not significantly different between the fluoroquinolone group and β-lactam plus macrolide group (P = 0.58). Increased 30-day readmissions were independently associated with male sex and hospital length of stay (P < 0.05). Length of stay was approximately 3 days and did not differ between treatment groups. Conclusions: No difference was seen in 30-day readmissions between CAP patients who received fluoroquinolone monotherapy and those who received β-lactam plus macrolide combination therapy.

Clinical Efficacy Protocol of Yinhuapinggan Granules: A Randomized, Double-Blind, Parallel, and Controlled Clinical Trial Program for the Intervention of Community-Acquired Drug-Resistant Bacterial Pneumonia as a Complementary Therapy

“…With its wide application in bacterial pneumonia, the detection rate and infection rate of various drug-resistant bacteria have also increased dramatically ( Hu et al, 2018 ), resulting in a significant increase in the incidence of drug-resistant bacterial pneumonia. Overuse of antibiotics, particularly fluoroquinolones ( Møller Gundersen et al, 2019 ; Gilbert et al, 2020 ), may increase the risk of MDR bacteria selection and nosocomial pneumonia, though convincing clinical data to support these possibilities are lacking ( Tamma et al, 2012 ). The clinical research of Adrie et al (2013) showed that the rates of secondary identification rate of MDR bacteria in the monotherapy and dual therapy groups was similar to the incidence of nosocomial pneumonia.…”

Antibiotic prescribing by age, sex, race, and ethnicity for patients admitted to the hospital with community-acquired bacterial pneumonia (CABP) in the All of Us database

“…Individuals at higher risk for these complications include those with hypertension, a history of circulatory blockages or aneurisms, select genetic disorders, and the elderly [21,[26][27][28]. Efficacy is similar between the two regimens; however, some studies have demonstrated that fluoroquinolone monotherapy leads to a reduces hospital LOS [9,[28][29][30][31]. β-Lactam plus macrolide combination therapy was the **Counts of less than or equal to 20 are displayed as ≤20 to comply with the All of Us data and statistic dissemination policy [33].…”

Impact on in-hospital mortality of ceftaroline versus standard of care in community-acquired pneumonia: a propensity-matched analysis

“…Both options are included as first-line choices in recent ATS guidelines [1]. Several studies have reported an association between the use of the combination of β-lactams plus macrolide and lower mortality in CAP, when compared to the use of β-lactams in monotherapy [28,29]. However, Postma et al [30].…”