Adding Azithromycin to Ceftriaxone Does Not Influence Treatment Duration for Community-Acquired Pneumonia

SAN DIEGO, CA— At IDWeek 2012, researchers presented that the addition of azithromycin to ceftriaxone therapy for children hospitalized with community-acquired pneumonia (CAP) was not associated with differences in length of stay.

Derek J. Williams, MD, MPH, from Vanderbilt University School of Medicine, Nashville, TN, and colleagues conducted a study to compare the effectiveness of ceftriaxone monotherapy vs. ceftriaxone plus azithromycin among children aged <18 years hospitalized with clinical and radiographic evidence of CAP at three children's hospitals. The study population only included children receiving initial therapy with ceftriaxone or ceftriaxone plus azithromycin during their first two days of hospitalization.

Of the 678 children included in the analyses, 522 (77%; median age 18 months) received ceftriaxone alone and 156 (23%; median age 57 months) received ceftriaxone plus azithromycin. Primary outcome was hospital length of stay, which was further examined using a propensity score matching strategy to reduce concerns about confounding by indication. Study results showed that median length of stay was similar between groups, 62 hours (ceftriaxone) vs. 58 hours (ceftriaxone plus azithromycin), with an adjusted hazard ratio (HR) 0.86 (95% confidence interval [CI], 0.7–1.05).  Propensity score matching retained 132 children in each exposure group, and results from this analysis were also similar (HR 0.94, 95% CI 0.74–1.2).

Dr. Williams and colleagues concluded that the azithromycin and ceftriaxone combination was not associated directly associated to the differences in length of stay for children hospitalized with CAP. However, they added that more analyses are needed to evaluate important subgroups and to examine additional clinical outcomes.