Study: 1 in 4 with Pneumonia Do Not Respond to Antibiotic Treatment

Antibiotic treatment failure for community-acquired pneumonia (CAP) occurs in approximately 1 in 4 patients, according to the results of a recent study presented at the American Thoracic Society 2017 International Conference.

The retrospective cohort study included 251,947 adults who received outpatient care for CAP between 2011 and 2015 (mean age 52.2 years, 47.7% were male), using data from the MarketScan Commercial Medicare Supplemental Databases. Patients included in the analysis were prescribed either macrolides, fluoroquinolones, beta-lactams, or tetracyclines. The researchers defined treatment failure as antibiotic refill, antibiotic switch, visit to the ER, or hospitalization.
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The most prescribed antibiotic was azithromycin, with 101,492 patients (40.3%) receiving a prescription, followed by levofloxacin, which was prescribed to 95,019 patients (37.7%).

A total of 55,741 patients (22.1%) experienced antibiotic failure.

Of the patients who experienced antibiotic failure, 11,492 (20.5%) patients refilled an antibiotic prescription, 39,397 patients switched antibiotics (70.7%), 1835 patients (3.3%) visited the ER, and 3015 patients (5.4%) were hospitalized.

Diagnosis of pneumococcal pneumonia, older age, and female gender were predictors associated with antibiotic failure. In addition, hemiplegia and paraplegia, rheumatologic disease, chronic pulmonary disease, cancer, diabetes, and asthma were associated with higher rates of antibiotic failure.

Compared with a score of zero on the Charlson Comorbidity Index (CCI), the researchers found that each increase in CCI score was associated with an increase in the probability of antibiotic failure.

Beta-lactams were associated with the highest antibiotic failure rate (25.7%) after researchers adjusted for baseline patient characteristics, followed by macrolides (22.9%), tetracyclines (22.5%), and fluoroquinolones (20.8%).

“Prescribers should be aware of those CAP patients at risk for poor outcomes and consider these factors to guide a comprehensive treatment plan, including more appropriate antibiotic treatment,” the researchers concluded.

—Melissa Weiss

Reference:

McKinnell K, Classi P, Blumberg P, Murty S, and Tillotson G. Clinical predictors of antibiotic failure in adult outpatients with community-acquired pneumonia. Presented at: American Thoracic Society 2017 International Conference; May 19-24, 2017; Washington, DC. Abstract 8450.