Is It Safe to Switch from Broad to Narrow-Spectrum Antibiotics in Healthcare-Associated Pneumonia?

Findings among clinically stable inpatients with healthcare-associated pneumonia
Findings among clinically stable inpatients with healthcare-associated pneumonia

(HealthDay News) — It may be safe to switch from broad- to narrow-spectrum antibiotic coverage once hospitalized patients with healthcare-associated pneumonia reach clinical stability, according to a study published online Oct. 3 in the Annals of the American Thoracic Society.

Whitney R. Buckel, Pharm.D., from Intermountain Medical Center in Murray, Utah, and colleagues compared the outcomes between patients who were transitioned to broad- (fluoroquinolone) versus narrow-spectrum (usually a beta-lactam) oral antibiotics after initially receiving broad-spectrum intravenous antibiotic coverage. The study included 173 inpatients with microbiology-negative healthcare-associated pneumonia (2010 to 2013).

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The researchers found that age, severity, comorbidity, length of intravenous therapy, and clinical response were similar between the two groups. The groups were also similar with respect to observed 30-day readmission (P = 0.26) and 30-day all-cause mortality (P = 0.68). Similarly, in multivariable analysis, there were no significant differences between narrow- and broad-spectrum oral antibiotic groups for adjusted odds of 30-day readmission (adjusted odds ratio, 0.56; P = 0.61) or 30-day all-cause mortality (adjusted odds ratio, 0.55; P = 0.26).

"Based on analysis of a limited number of patient observed retrospectively, our findings suggest that it may be safe to switch from broad-spectrum intravenous antibiotic coverage to a narrow-spectrum oral antibiotic once clinical stability is achieved for hospitalized patients with healthcare-associated pneumonia when no microbiological diagnosis is made," the authors write.

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