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Antimicrob. Agents Chemother. doi:10.1128/AAC.00006-07
Copyright (c) 2007, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Comparison of -lactam and Macrolide Combination Therapy vs. Fluoroquinolone Monotherapy in Hospitalized Veteran Affairs' Patients with Community-Acquired Pneumonia

Albany College of Pharmacy, Albany, New York; Ordway Research Institute, Albany, New York; Singapore General Hospital, Singapore, Stratton VA Medical Center, Albany, New York

^* To whom correspondence should be addressed. Email: lodiset{at}acp.edu.

	Abstract

Background: Data comparing outcomes between the two most frequently recommended empirical antibiotic regimens for Community-acquired pneumonia (CAP) (combination therapy with an extended spectrum -lactam with a macrolide (BL+M) or fluoroquinolone (F) monotherapy) in patients with severe CAP is sparse. The purpose of this study was to compare empirical BL+M combination therapy vs. F monotherapy in Veteran's affairs (VA) patients with severe CAP.

Methods: This retrospective study included patients with CAP that received empirical therapy with BL+M or F between 10/1999 and 5/2003 in the Upstate New York VA Network. Outcome measures were 14-day, 30-day mortality and hospital length of stay (LOS). Severe CAP was defined as patients with class V Pneumonia Severity Index (PSI).

Results: During the study period, 261 patients received BL+M and 254 received F. Disease severity was similar between treatment groups at admission and presence of tachycardia was the only difference noted. In PSI class V patients, there was a lower rate of 14-day and 30-day mortality in BL+M vs. F (14-day: 8.2% versus 26.8%, P=0.02; 30-day: 18.4% vs. 36.6%, P=0.05). No differences in mortality between treatment groups were noted for the lower PSI classes. Overall median LOS was significantly longer among the -lactam and macrolide combination group compared to the fluoroquinolone monotherapy (6.0 days versus 5.0 days respectively; p=0.01) but no difference in LOS was noted among PSI class V patients.

Conclusion: Our study showed that improved outcomes may be realized with BL+M in severe CAP. A randomized clinical study is warranted based on these results.