Comparative treatment failure rates of respiratory fluoroquinolones or β-lactam + macrolide versus β-lactam alone in the treatment for community-Acquired pneumonia in adult outpatients: An analysis of a nationally representative claims database
Journal
Medicine (United States)
Journal Volume
94
Journal Issue
39
Pages
e1662
Date Issued
2015
Author(s)
Abstract
No comparative effectiveness study has been conducted for the following 3 antibiotics: respiratory uoroquinolone, b-lactam, and blactam + advanced macrolide. To gain insights into the real-world clinical effectiveness of these antibiotics for community-Acquired pneumonia in adult outpatients, our study investigated the treatment failure rates in 2 million representative participants from the National Health Informatics Project (NHIP) of Taiwan. A new-user cohort design was used to follow NHIP participants from January 2000 until December 2009. Treatment failure was defined by either one of the following events: a second antibiotic prescription, hospitalization due to CAP, an emergency department visit with a diagnosis of CAP, or 30-day nonaccident-related mortality. From 2006 to 2009, we identified 9256 newly diagnosed CAP outpatients, 1602 of whom were prescribed levofloxacin, 2100 were prescribed moxifloxacin, 5049 were prescribed β-lactam alone, and 505 were prescribed advanced macrolide +β-lactam. Compared with the β-lactam-based regimen, the propensity score-matched odds ratio for composite treatment failure was 0.81 (95% CI, 0.67-0.97) for moxifloxacin, 1.10 (95% CI, 0.90-1.35) for levofloxacin, and 0.95 (95% CI, 0.67-1.35) for macrolide +β-lactam. Moxifloxacin was associated with lower treatment failure rates compared with β-lactam alone, or levofloxacin in Taiwanese CAP outpatients. However, due to inherent limitations in our claims database, more randomized controlled trials are required before coming to a conclusion on which antibiotic is more effective for Taiwanese CAP outpatients. More population-based comparative effectiveness studies are also encouraged and should be considered as an integral piece of evidence in local CAP treatment guidelines. Copyright ? 2015 Wolters Kluwer Health, Inc. All rights reserved.
SDGs
Other Subjects
amoxicillin plus clavulanic acid; azithromycin; clarithromycin; levofloxacin; moxifloxacin; sultamicillin; antiinfective agent; beta lactam; macrolide; quinolone derivative; adolescent; adult; aged; antibiotic therapy; Article; child; clinical effectiveness; cohort analysis; community acquired pneumonia; comparative effectiveness; controlled study; drug treatment failure; emergency ward; female; hospitalization; human; major clinical study; male; outpatient; prescription; priority journal; randomized controlled trial; Taiwan; treatment duration; ambulatory care; community acquired infection; comparative study; factual database; insurance; middle aged; Pneumonia, Bacterial; treatment failure; Adult; Aged; Ambulatory Care; Anti-Bacterial Agents; beta-Lactams; Community-Acquired Infections; Databases, Factual; Female; Fluoroquinolones; Humans; Insurance Claim Review; Macrolides; Male; Middle Aged; Pneumonia, Bacterial; Taiwan; Treatment Failure
Type
journal article