NEJM Research Discusses Right Antibiotic Strategy For Community-Acquired Pneumonia in Adults

Henri van Werkhoven PhD student | Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht, The NetherlandsMedicalResearch.com Interview with:
Henri van Werkhoven
PhD student and

Douwe-PostmaDouwe Postma
PhD student
Julius Center for Health Sciences and Primary Care
University Medical Center Utrecht, Utrecht, The Netherlands

Medical Research: What is the background for this study? What are the main findings?

Response: Community-acquired pneumonia is an important cause of hospitalization and death worldwide. Recommendations for antibiotic treatment in patients hospitalized to a non-ICU ward vary widely between guidelines, because the optimal antibiotic strategy is unknown. Interpretation of the available evidence from clinical studies is complicated by the heterogeneity in designs and findings. In our study, we hypothesized that the most conservative strategy, beta-lactam monotherapy, would be non-inferior to strategies with a broader range of antibiotic coverage. The latter strategies are potentially related to increased antibiotic resistance.

For this purpose, we randomized hospitals to follow three different strategies of preferred antibiotic treatment in consecutive periods of four months. Physicians were allowed to deviate from the preferred antibiotic treatment for medical reasons. We found that a strategy with beta-lactam monotherapy (e.g. amoxicillin) as the preferred treatment was non-inferior to the strategies with beta-lactam/macrolide combination therapy or fluoroquinolone monotherapy for 30 and 90-day all-cause mortality. Also there was no difference in length of hospitalization and rate of complications.

Medical Research: What should clinicians and patients take away from your report?

Response: Most patients hospitalized to a non-ICU ward with community-acquired pneumonia can be safely treated with a beta-lactam without compromising patient outcome.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Within the group of beta-lactam antibiotics used as beta-lactam monotherapy for treating pneumonia, the spectrum of antimicrobial coverage is still very diverse (e.g. ceftriaxone vs. amoxicillin). A new study from our institution (currently in design phase) will address whether an antibiotic stewardship program in which penicillin and amoxicillin use is advised as the preferred antibiotic treatment will be non-inferior on patient outcome compared to standard care.

Citation:

 

Antibiotic Treatment Strategies for Community-Acquired Pneumonia in Adults

Douwe F. Postma, M.D., Cornelis H. van Werkhoven, M.D., Leontine J.R. van Elden, M.D., Ph.D., Steven F.T. Thijsen, M.D., Ph.D., Andy I.M. Hoepelman, M.D., Ph.D., Jan A.J.W. Kluytmans, M.D., Ph.D., Wim G. Boersma, M.D., Ph.D., Clara J. Compaijen, M.D., Eva van der Wall, M.D., Jan M. Prins, M.D., Ph.D., Jan J. Oosterheert, M.D., Ph.D., and Marc J.M. Bonten, M.D., Ph.D. for the CAP-START Study Group

N Engl J Med 2015; 372:1312-1323
April 2, 2015DOI: 10.1056/NEJMoa1406330

 

MedicalResearch.com Interview with: Henri van Werkhoven (2015). Antibiotic Treatment Strategies for Community-Acquired Pneumonia in Adults