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Comparative Efficacy of Antibiotic Regimens for Non-Severe Community Acquired Pneumonia Revealed in Multi-Center Study

A recent investigation, recounted in the medical journal Chest, has revealed the comparative effectiveness of different antibiotic treatment methods used for patients diagnosed with non-severe community acquired pneumonia (CAP). The research took into account patients who were hospitalized due to CAP but did not require intensive care unit (ICU) treatment.

This significant study was based on data drawn from the GEMINI database, employing a target trial strategy and encompassing a sample of 23,512 adult patients across 19 acute care hospitals in Ontario, Canada over a period of nearly six years, from January 2015 to December 2021.

Patients were categorized into four separate cohorts each exhibiting a different antibiotic regimen. As per the findings, the median duration of antibiotic treatment in the hospital ranged from 5 to 6 days across all cohorts. The median length of time from admission to discharge or death varied slightly between the groups, with the shortest being 4.6 days and the longest hitting 6 days.

Interestingly, the study showed that the primary outcome of in-hospital mortality was generally similar among those treated with three specific antibiotic regimens, namely β-lactam plus macrolide (BL+M), fluoroquinolone (FQ), and β-lactam plus doxycycline (BL+D). Specifically, 703 (7.5%) patients treated with BL+M died in the hospital, versus 888 (9.7%) in the BL cohort, 302 (6.7%) receiving FQ, and 31 (6.0%) treated with BL+D. After adjusting for potential confounding factors, no significant differences were found in the risk of in-hospital mortality between these treatment methods.

The study also evaluated patient readmission within 30 days post-discharge and found readmission rates between 10.1% to 15.4%. Delving into ancillary outcomes, the study identified that patients treated with BL alone had a slightly less likelihood for successful discharge compared to those with the BL+M regimen. The BL+D group had no cases of Clostridioides difficile colitis.

The research does recognize its own limitations, most notably the focus solely on in-hospital mortality and the potential for residual confounding.

The study proficiently asserted that BL+M, FQ and BL+D regimens may achieve similar results for non-severe CAP treatment, although BL treatment may potentially cause a negligible increase in risk along with a longer time to discharge.


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