Antibiotic Failure in Community Acquired Pneumonia Surprisingly Common Interview with:

Dr. James A. McKinnell, MD LA BioMed Assistant Professor of Medicine David Geffen School of Medicine at UCLA

Dr. McKinnell

Dr. James A. McKinnell, MD
LA BioMed
Assistant Professor of Medicine
David Geffen School of Medicine at UCLA What is the background for this study?

Response: Pneumonia is the leading cause of death from infectious disease in the United States. We conducted this study because current community-acquired pneumonia guidelines from the American Thoracic Society and the Infectious Disease Society America, published in 2007, provide some direction about prescribing antibiotics for community-acquired pneumonia. But large-scale, real-world data are needed to better understand and optimize antibiotic choices and to better define clinical risk factors that may be associated with treatment failure. Antibiotic failure for community-acquired pneumonia is associated with substantial morbidity and mortality and results in significant medical expenditures.

We examined databases containing records for 251,947 adult patients who were treated between 2011 and 2015 with a single class of antibiotics (beta-lactam, macrolide, tetracycline, or fluoroquinolone) following a visit to their physician for treatment for community-acquired pneumonia. We defined treatment failure as either the need to refill antibiotic prescriptions, antibiotic switch, ER visit or hospitalization within 30 days of receipt of the initial antibiotic prescription. What are the main findings?

Response: Approximately one in four (22.1%) adults prescribed an antibiotic in an outpatient setting (such as a doctor’s office) for community-acquired pneumonia does not respond to treatment. Patients with certain characteristics — such as older age, or having certain other diseases in addition to pneumonia — had higher rates of drug failure.

After adjusting for patient characteristics, the failure rates by class of antibiotic were: beta-lactams (25.7%), macrolides (22.9%), tetracyclines (22.5%), and fluoroquinolones (20.8%).

Especially concerning is the fact that antibiotic failure often leads to additional antibiotic therapy, which increases the risk of antibiotic resistance and complications like C. difficile (“C diff”) infection, which is difficult to treat and may be life-threatening, especially for older adults. What should readers take away from your report?

Response: Our findings suggest that the community-acquired pneumonia treatment guidelines should be updated with more robust data on risk factors for clinical failure. Our data also provide numerous insights into characteristics of patients who are at higher risk of complications and clinical failure. Perhaps the most striking example is the association between age and hospitalization: Patients over the age of 65 were nearly twice as likely to be hospitalized compared to younger patients when our analysis was risk adjusted and nearly three times more likely in unadjusted analysis. Elderly patients are more vulnerable and should be treated more carefully, potentially with more aggressive antibiotic therapy.

The study found substantial regional variations in treatment outcomes, which are not addressed in a specific way in the community-acquired pneumonia guidelines. In addition, the study showed that thousands of patients who suffer from other conditions – such as chronic obstructive pulmonary disease, cancer or diabetes – were not treated with combination antibiotic therapy or respiratory fluoroquinolone, as the guidelines recommend. What recommendations do you have for future research as a result of this study?

Response: While certain aspects of the guidelines need to be updated, some prescribers also have room for improvement and should implement the current guidelines.

James A McKinnell, MD, is an infectious disease specialist and lead researcher at LA BioMed, a nonprofit biomedical research institute in Los Angeles. He presented these findings at the 2017 American Thoracic Society International Conference. Thank you for your contribution to the community.

2017 American Thoracic Society International Conference abstract:

Clinical Predictors of Antibiotic Failure in Adult Outpatients with Community-Acquired Pneumonia
James McKinnell , Peter Classi , Pamela Blumberg , Sharanya Murty , Glenn Tillotson ,

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on May 22, 2017 by Marie Benz MD FAAD