Abstract

Comparison of β-Lactam and Macrolide Combination Therapy versus Fluoroquinolone Monotherapy in Hospitalized Veterans Affairs Patients with Community-Acquired Pneumonia ▿ Thomas P. Lodise 1 , 2 , * , Andrea Kwa 1 , 3 , Leon Cosler 1 , Reetu Gupta 1 and Raymond P. Smith 4 1 Albany College of Pharmacy 2 Ordway Research Institute 4 Stratton VA Medical Center, Albany, New York 3 Singapore General Hospital, Singapore ABSTRACT Data comparing the treatment outcomes of the two most frequently recommended empirical antibiotic regimens for community-acquired pneumonia (CAP)—combination therapy with an extended-spectrum β-lactam and a macrolide (BL+M) or fluoroquinolone (F) monotherapy—for patients with severe CAP are sparse. The purpose of this study was to compare empirical BL+M combination therapy with F monotherapy for Veterans Affairs (VA) patients with severe CAP. This retrospective study included patients with CAP who received empirical therapy with BL+M or F between October 1999 and May 2003 in the Upstate New York VA Network. Outcome measures were 14-day mortality, 30-day mortality, and length of hospital stay (LOS). Severe CAP was defined as a class V pneumonia severity index (PSI). During the study period, 261 patients received BL+M and 254 received F. Disease severity was similar for the two treatment groups at admission, and the presence of tachycardia was the only difference noted. For PSI class V patients, there were lower 14-day and 30-day mortality rates with BL+M than with F (14-day rates, 8.2% versus 26.8% ( P = 0.02); 30-day rates, 18.4% versus 36.6% ( P = 0.05)). No differences in mortality between treatment groups were noted for the lower PSI classes. The overall median LOS was significantly longer for the BL+M combination group than for the F monotherapy group (6.0 days versus 5.0 days, respectively ( P = 0.01)), but no difference in LOS was noted among PSI class V patients. Our study showed that improved outcomes may be realized with BL+M in cases of severe CAP. A randomized clinical study is warranted based on these results.