Single Antibiotic Noninferior to Combo Drug for Pneumonia

Guideline-recommended antibiotics may not be superior to other antibiotic treatment options for patients with nonsevere community-acquired pneumonia (CAP), according to a trial.

In an effort to gather more evidence on the efficacy of antibiotic treatment in patients with CAP, researchers conducted a cluster-randomized, crossover trial comparing the effects of beta-lactam monotherapy, fluoroquinolone monotherapy, and beta-lactam–macrolide combination therapy.
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Note: Current guidelines recommend fluoroquinolone monotherapy or a beta-lactam plus a macrolide for the treatment of patients with CAP.

Overall, 656 patients were given beta-lactam, 739 were given beta-lactam—macrolide, and 888 were given fluoroquinolone. Ninety-day mortality rates were 9%, 11.1%, and 8.8%, respectively. 

“Among patients with clinically suspected CAP admitted to non-ICU wards, a strategy of preferred empirical treatment with beta-lactam monotherapy was noninferior to strategies with a beta-lactam–macrolide combination or fluoroquinolone monotherapy with regard to 90-day mortality,” they concluded.

The full study was published in the New England Journal of Medicine.

—Michael Potts

Reference:

Postma DF, van Werkhoven CH, van Elden LJR, et al. Antibiotic treatment strategies for community-acquired pneumonia in adults. N Engl J Med. 2015; 372:1312-1323.