Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases Pub Date : 2024-10-23 DOI:10.1093/cid/ciae519

Anne M Butler, Katelin B Nickel, Margaret A Olsen, John M Sahrmann, Ryan Colvin, Elizabeth Neuner, Caroline A O’Neil, Victoria J Fraser, Michael J Durkin

{"title":"Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults","authors":"Anne M Butler, Katelin B Nickel, Margaret A Olsen, John M Sahrmann, Ryan Colvin, Elizabeth Neuner, Caroline A O’Neil, Victoria J Fraser, Michael J Durkin","doi":"10.1093/cid/ciae519","DOIUrl":null,"url":null,"abstract":"Background Evidence is limited about the comparative safety of antibiotic regimens for treatment of community-acquired pneumonia (CAP). We compared the risk of adverse drug events (ADEs) associated with antibiotic regimens for CAP treatment among otherwise healthy, non-elderly adults. Methods We conducted an active comparator new-user cohort study (2007-2019) of commercially-insured adults 18–64 years diagnosed with outpatient CAP, evaluated via chest x-ray, and dispensed a same-day CAP-related oral antibiotic regimen. ADE follow-up duration ranged from 2–90 days (e.g., renal failure [14 days]). We estimated risk differences [RD] per 100 treatment episodes and risk ratios using propensity score weighted Kaplan-Meier functions. Ankle/knee sprain and influenza vaccination were considered as negative control outcomes. Results Of 145,137 otherwise healthy CAP patients without comorbidities, 52% received narrow-spectrum regimens (44% macrolide, 8% doxycycline) and 48% received broad-spectrum regimens (39% fluoroquinolone, 7% β-lactam, 3% β-lactam + macrolide). Compared to macrolide monotherapy, each broad-spectrum antibiotic regimen was associated with increased risk of several ADEs (e.g., β-lactam: nausea/vomiting/abdominal pain [RD per 100, 0.32; 95% CI, 0.10–0.57]; non-Clostridioides difficile diarrhea [RD per 100, 0.46; 95% CI, 0.25–0.68]; vulvovaginal candidiasis/vaginitis [RD per 100, 0.36; 95% CI, 0.09–0.69]). Narrow-spectrum antibiotic regimens largely conferred similar risk of ADEs. We generally observed similar risks of each negative control outcome, indicating minimal confounding. Conclusions Broad-spectrum antibiotics were associated with increased risk of ADEs among otherwise healthy adults treated for CAP in the outpatient setting. Antimicrobial stewardship is needed to promote judicious use of broad-spectrum antibiotics and ultimately decrease antibiotic-related ADEs.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":8.2000,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/cid/ciae519","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background Evidence is limited about the comparative safety of antibiotic regimens for treatment of community-acquired pneumonia (CAP). We compared the risk of adverse drug events (ADEs) associated with antibiotic regimens for CAP treatment among otherwise healthy, non-elderly adults. Methods We conducted an active comparator new-user cohort study (2007-2019) of commercially-insured adults 18–64 years diagnosed with outpatient CAP, evaluated via chest x-ray, and dispensed a same-day CAP-related oral antibiotic regimen. ADE follow-up duration ranged from 2–90 days (e.g., renal failure [14 days]). We estimated risk differences [RD] per 100 treatment episodes and risk ratios using propensity score weighted Kaplan-Meier functions. Ankle/knee sprain and influenza vaccination were considered as negative control outcomes. Results Of 145,137 otherwise healthy CAP patients without comorbidities, 52% received narrow-spectrum regimens (44% macrolide, 8% doxycycline) and 48% received broad-spectrum regimens (39% fluoroquinolone, 7% β-lactam, 3% β-lactam + macrolide). Compared to macrolide monotherapy, each broad-spectrum antibiotic regimen was associated with increased risk of several ADEs (e.g., β-lactam: nausea/vomiting/abdominal pain [RD per 100, 0.32; 95% CI, 0.10–0.57]; non-Clostridioides difficile diarrhea [RD per 100, 0.46; 95% CI, 0.25–0.68]; vulvovaginal candidiasis/vaginitis [RD per 100, 0.36; 95% CI, 0.09–0.69]). Narrow-spectrum antibiotic regimens largely conferred similar risk of ADEs. We generally observed similar risks of each negative control outcome, indicating minimal confounding. Conclusions Broad-spectrum antibiotics were associated with increased risk of ADEs among otherwise healthy adults treated for CAP in the outpatient setting. Antimicrobial stewardship is needed to promote judicious use of broad-spectrum antibiotics and ultimately decrease antibiotic-related ADEs.

查看原文本刊更多论文

不同抗生素方案治疗门诊社区获得性肺炎的安全性比较

背景关于治疗社区获得性肺炎（CAP）的抗生素方案的安全性比较证据有限。我们比较了与抗生素治疗方案相关的药物不良事件 (ADE) 风险，这些抗生素用于治疗其他健康的非老年成年人的 CAP。方法我们对 18-64 岁的商业保险成年人进行了一项新用户队列研究（2007-2019 年），这些成年人在门诊被诊断为 CAP，通过胸部 X 光片进行了评估，并在当天获得了与 CAP 相关的口服抗生素治疗方案。ADE 随访时间为 2-90 天（如肾衰竭 [14 天]）。我们使用倾向得分加权卡普兰-梅耶函数估算了每 100 次治疗的风险差异 [RD] 和风险比。踝关节/膝关节扭伤和流感疫苗接种被视为阴性对照结果。结果在145137名无合并症的健康CAP患者中，52%接受了窄谱疗法（44%大环内酯类，8%强力霉素），48%接受了广谱疗法（39%氟喹诺酮类，7%β-内酰胺类，3%β-内酰胺类+大环内酯类）。与单用大环内酯类药物相比，每种广谱抗生素方案都会增加几种 ADE 的风险（如β-内酰胺类：恶心/呕吐/腹痛[RD/100，0.32；95% CI，0.10-0.57]；非梭菌性艰难梭菌腹泻[RD/100，0.46；95% CI，0.25-0.68]；外阴阴道念珠菌病/阴道炎[RD/100，0.36；95% CI，0.09-0.69])。窄谱抗生素治疗方案的ADEs风险基本相似。我们普遍观察到每种阴性对照结果的风险相似，这表明混杂因素极少。结论在门诊环境中接受 CAP 治疗的健康成人中，广谱抗生素与 ADE 风险增加有关。需要加强抗菌药物管理以促进广谱抗生素的合理使用，并最终减少与抗生素相关的 ADE。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Infectious Diseases 医学-传染病学

CiteScore

25.00

自引率

2.50%

发文量

900

审稿时长

3 months

期刊介绍： Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.