Comparative Safety of Different Antibiotic Regimens for the Treatment of Outpatient Community-Acquired Pneumonia Among Otherwise Healthy Adults
Anne Mobley Butler, PhD, Assistant Professor of Medicine, WashU Medicine – Division of Infectious Diseases, was recently shared in the IDSA daily news briefing. IDSA Daily News Briefing is written and distributed by the editors of Bulletin Healthcare, as a member benefit of the Infectious Diseases Society of America.
There is limited evidence about the comparative safety of different antibiotics for the treatment of community-acquired pneumonia (CAP) in the outpatient setting. Using a national commercial insurance claims database, we compared the risk of adverse drug events in approximately 145,000 otherwise healthy, non-elderly adults treated for CAP in the outpatient setting by antibiotic regimen.
Among otherwise healthy, non-elderly adults treated for community-acquired pneumonia in the outpatient setting, broad-spectrum antibiotics were associated with increased risk of adverse drug events compared to narrow-spectrum antibiotics. Ultimately, knowledge about antibiotic-related harms can help patients, prescribers, and stewardship programs make judicious decisions about antibiotic utilization.
Among adults treated for CAP, 52% received a narrow-spectrum antibiotic regimen (44% macrolide, 8% doxycycline) and 48% received a broad-spectrum antibiotic regimen (39% fluoroquinolone, 7% β-lactam, 3% β-lactam + macrolide). Compared to macrolide monotherapy—a narrow-spectrum antibiotic that is generally considered safe—each broad-spectrum antibiotic regimen was associated with increased risk of several individual adverse drug events.
For example, β-lactam regimens were associated with an increase of 3.2 per 1,000 treatment episodes of nausea/vomiting/abdominal pain and 4.6 per 1,000 treatment episodes of non-Clostridioides difficile diarrhea compared to macrolide treatment, even after accounting for differences in patient populations. Antimicrobial stewardship is needed to promote thoughtful use of broad-spectrum antibiotics and decrease antibiotic-related adverse drug events. Antimicrobial stewardship efforts are needed to promote judicious use of broad-spectrum antibiotics, and ultimately decrease antibiotic-related ADEs [adverse drug events].
The findings were published in Clinical Infectious Diseases.
Butler AM, Nickel KB, Olsen MA, Sahrmann JM, Colvin R, Neuner E, O’Neil CA, Fraser VJ, Durkin MJ. Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults. Clin Infect Dis. 2024 Oct 23:ciae519. doi: 10.1093/cid/ciae519. Epub ahead of print. PMID: 39442057.