Effect of Macrolides as Part of Initial Empiric Therapy on Length of Stay in Patients Hospitalized With Community-Acquired Pneumonia

Stahl, James E.; Barza, Michael; DesJardin, Jeffrey A.; Martin, Rhonda; Eckman, Mark H.

doi:10.1001/archinte.159.21.2576

Cited by 150 publications

(78 citation statements)

References 32 publications

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“…Several retrospective studies have suggested that the use of a macrolides/b-lactams combination, as part of the initial antimicrobial treatment, for patients with CAP, requiring hospital admission, may shorten the hospital stay [6,7] and reduce the mortality rate in comparison with those treated with monotherapy [8][9][10], even when S. pneumoniae is finally identified as the causative organism [11][12][13]. However, many aspects of the apparently beneficial effects of combined therapy remain unclear and/or controversial.…”

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confidence: 99%

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

Aspa¹,

Rajas²,

Castro³

et al. 2006

Eur Respir J

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To determine the impact of initial antimicrobial choice on 30-day mortality rate in patients with community-acquired pneumonia due to Streptococcus pneumoniae (CAP-SP), a prospective, observational study was conducted in 35 Spanish hospitals. A total of 638 patients with CAP-SP were identified. Antimicrobials were chosen by the attending physician. Patients were grouped into the following categories: b-lactam monotherapy (n5251), macrolide monotherapy (n537), b-lactam plus macrolide (n5198), levofloxacin alone/combination (n548), and other combinations (n5104). The reference category was b-lactam+macrolide.The 30-day survival probability was 84.9%. Using multivariate survival analysis, factors related to mortality in the entire population were: bilateral disease, suspected aspiration, shock, HIV infection, renal failure and pneumonia severity index (PSI) score Class IV versus I-III and categories V versus I-III. The association of b-lactams+macrolides was not better than the use of b-lactams alone. The current authors analysed the different groups of patients with significant mortality/morbidity: intensive care unit, PSI Class .III, renal failure, chronic lung disease and bacteraemia. Only in patients with PSI Class .III, who had undergone initial antimicrobial choice classified as other combinations, were associated with higher mortality.In conclusion, the current authors have not demonstrated an independent association between initial antimicrobial regimen and 30-day mortality in community-acquired pneumococcal pneumonia patients, except for those with a higher pneumonia severity index score.

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confidence: 99%

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

Aspa¹,

Rajas²,

Castro³

et al. 2006

Eur Respir J

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“…This study also revealed a significant association between age and antibiotic therapy prescribed for levofloxacin, azithromycin, and meropenem among pilgrims. The old medical guideline has revealed that the outcome for elderly patients (age over 65 years with comorbidities) with CAP may improve when a macrolide agent (azithromycin, erythromycin, or clarithromycin) is combined with a second-or third-generation cephalosporin [44,45]. High frequency of atypical pathogens causing mixed pneumonia might be categorised as a key success of the macrolide agent [46].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic therapy of choice for community-acquired pneumonia in Malaysian Hajj pilgrims: the pattern and associated factors

Dzaraly¹,

Rahman²,

Haque³

et al. 2017

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Introduction: Pneumonia is a potentially life-threatening illness that poses global health teething troubles particularly among elderly population and performing Hajj. Empirical antibiotic treatment has been recommended for all suspected community-acquired pneumonia (CAP) patients as initial treatment on admission. Aim of the research: To describe the antibiotic therapy of CAP and determine the associated factors related to the treatment options among Malaysian Hajj pilgrims. Material and methods: This was a cross-sectional study involving 91 patients who were admitted to Tabung Haji Hospital, Makkah in 2012, with the clinical diagnosis of pneumonia during Hajj season. The antibiotic treatment for the patients as well as demographic factors and co-morbidity, which potentially influence the treatment options, were studied. Results: The mean age of the hajj pilgrims was 71.4 ±8.7 years. The most frequently prescribed antibiotic was levofloxacin (44.0%), followed by azithromycin (40.7%), cefuroxime (23.1%), ampicillin + sulbactam (16.5%), and amoxicillin + clavulanate (15.4%). The age of patients was significantly associated with levofloxacin, azithromycin, and meropenem (p = 0.032, 0.028, and 0.026, respectively). Patients with diabetes were statistically significantly highly prescribed with cefuroxime (p = 0.036). Conclusions: Levofloxacin and azithromycin were classified as the most common antibiotic treatment given to Malaysian Hajj pilgrim with CAP and their choice was associated with older age of patients. Otherwise, cefuroxime was the prescription of choice in diabetics.

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“…In a study including more than 3,200 patients, Yealy et al found that 71.9% of hospitalizations were in Table 2 immunomodulatory effect of macrolides than to the antimicrobial effect of those antibiotics. (23) Broad-spectrum antibiotic therapy, including the combined use of beta-lactam antibiotics and macrolides, aims at broadening the coverage of gram-negative bacteria, as well as of atypical or resistant pathogens. However, the incidence of such agents is higher in cases that are more severe, S. pneumoniae remaining the principal etiologic agent in CAP that is less severe (CURB-65 score, 0-1).…”

Section: Discussionmentioning

confidence: 99%

Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário

2012

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Objective: To evaluate the agreement between the criteria used for hospitalization of patients with communityacquired pneumonia (CAP) and those of the Brazilian Thoracic Association guidelines, and to evaluate the association of that agreement with 30-day mortality. Secondarily, to evaluate the agreement between the treatment given and that recommended in the guidelines with length of hospital stay, microbiological profile, 12-month mortality, complications, ICU admission, mechanical ventilation, and 30-day mortality. Methods: This was a retrospective study involving adult patients hospitalized between 2005 and 2007 at the Federal University of Minas Gerais Hospital das Clínicas, located in Belo Horizonte, Brazil. Medical charts and chest X-rays were reviewed. Results:Among the 112 patients included in the study, admission and treatment criteria were in accordance with the guidelines in 82 (73.2%) and 66 (58.9%), respectively. The 30-day and 12-month mortality rates were 12.3% and 19.4%, respectively. The 30-day mortality rate was lower for patients in whom the CRB-65 (mental Confusion, Respiratory rate, Blood pressure, and age ≥ 65 years) score was 1-2 and the antibiotic therapy was in accordance with the guidelines (p = 0.01). Cerebrovascular disease and appropriate antibiotic therapy showed independent associations with 30-day mortality. There was a trend toward an association between guidelineconcordant antibiotic therapy and shorter hospital stay. Conclusions: In the population studied, admission and treatment criteria that were in accordance with the guidelines were associated with favorable outcomes in hospitalized patients with CAP. Cerebrovascular disease, as a risk factor, and guideline-concordant antibiotic therapy, as a protective factor, were associated with 30-day mortality.Keywords: Pneumonia/therapy; Pneumonia/mortality; Hospitalization; Guideline adherence. ResumoObjetivo: Avaliar a concordância entre os critérios de hospitalização utilizados para a admissão de pacientes com pneumonia adquirida na comunidade (PAC) e aqueles da Sociedade Brasileira de Pneumologia e Tisiologia e avaliar a associação dessa concordância com a taxa de mortalidade em 30 dias. Secundariamente, avaliar a associação da concordância entre o tratamento instituído e as recomendações dessas diretrizes com duração da internação hospitalar, investigação microbiológica, mortalidade em 12 meses, complicações, internação em UTI, ventilação mecânica e mortalidade em 30 dias. Métodos: Estudo retrospectivo que incluiu pacientes adultos internados entre 2005 e 2007 no Hospital das Clínicas da Universidade Federal de Minas Gerais, na cidade de Belo Horizonte (MG). Foram revisados prontuários e radiografias de tórax. Resultados: Dentre os 112 pacientes incluídos, os critérios de internação e de tratamento foram concordantes com as diretrizes em 82 (73,2%) e 66 (58,9%), respectivamente. A taxa de mortalidade em 30 dias e em 12 meses foi de 12,3% e 19,4%, respectivamente. Pacientes com escore de CRP-65 (Confusão mental, frequênci...

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Effect of Macrolides as Part of Initial Empiric Therapy on Length of Stay in Patients Hospitalized With Community-Acquired Pneumonia

Abstract: Use of macrolides as part of an initial therapeutic regimen appears to be associated with shorter LOS.

Cited by 150 publications

References 32 publications

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

Antibiotic therapy of choice for community-acquired pneumonia in Malaysian Hajj pilgrims: the pattern and associated factors

Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário

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