The order of administration of macrolides and beta-lactams may impact the outcomes of hospitalized patients with community-acquired pneumonia: results from the community-acquired pneumonia organization.

Autor: Peyrani P; a Division of Infectious Diseases , University of Louisville , Louisville , KY , USA., Wiemken TL; a Division of Infectious Diseases , University of Louisville , Louisville , KY , USA.; b Department of Epidemiology and Population Health , School of Public Health and Information Sciences, University of Louisville , Louisville , KY , USA., Metersky ML; c Division of Pulmonary and Critical Care Medicine , University of Connecticut School of Medicine , Farmington , CT , USA., Arnold FW; a Division of Infectious Diseases , University of Louisville , Louisville , KY , USA., Mattingly WA; a Division of Infectious Diseases , University of Louisville , Louisville , KY , USA., Feldman C; d Division of Pulmonology, Faculty of Health Sciences , University of the Witwatersrand Medical School , Johannesburg , South Africa., Cavallazzi R; e Division of Pulmonary and Critical Care Medicine , University of Louisville , Louisville , KY , USA., Fernandez-Botran R; f Department of Pathology and Laboratory Medicine , University of Louisville , Louisville , KY , USA., Bordon J; g Section of Infectious Diseases , Providence Hospital , Washington, D.C , USA., Ramirez JA; a Division of Infectious Diseases , University of Louisville , Louisville , KY , USA.
Jazyk: angličtina
Zdroj: Infectious diseases (London, England) [Infect Dis (Lond)] 2018 Jan; Vol. 50 (1), pp. 13-20. Date of Electronic Publication: 2017 Jul 12.
DOI: 10.1080/23744235.2017.1350881
Abstrakt: Background: The beneficial effect of macrolides for the treatment of community-acquired pneumonia (CAP) in combination with beta-lactams may be due to their anti-inflammatory activity. In patients with pneumococcal meningitis, the use of steroids improves outcomes only if they are administered before beta-lactams. The objective of this study was to compare outcomes in hospitalized patients with CAP when macrolides were administered before, simultaneously with, or after beta-lactams.
Methods: Secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study database. Study groups were defined based on the sequence of administration of macrolides and beta-lactams. The study outcomes were time to clinical stability (TCS), length of stay (LOS) and in-hospital mortality. Accelerated failure time models were used to evaluate the adjusted impact of sequential antibiotic administration and time-to-event outcomes, while a logistic regression model was used to evaluate their adjusted impact on mortality.
Results: A total of 99 patients were included in the macrolide before group and 305 in the macrolide after group. Administration of a macrolide before a beta-lactam compared to after a beta-lactam reduced TCS (3 vs. 4 days, p = .011), LOS (6 vs. 7 days, p = .002) and mortality (3 vs. 7.2%, p = .228).
Conclusions: The administration of macrolides before beta-lactams was associated with a statistically significant decrease in TCS and LOS and a non-statistically significant decrease in mortality. The beneficial effect of macrolides in hospitalized patient with CAP may occur only if administered before beta-lactams.
Databáze: MEDLINE
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