PHILADELPHIA, PA—Beta-lactam monotherapy proved to be non-inferior to beta-lactam/macrolide combination therapy (BLM) or fluoroquinolone monotherapy in patients with community-acquired pneumonia (CAP), with regards to mortality risk, length of hospital stay, and time to oral treatment, according to data presented at IDWeek 2014.

Douwe F. Postma, MD, of the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands, and colleagues compared empirical treatment strategies of beta-lactam monotherapy, BLM, and fluoroquinolone monotherapy in a cluster-randomized trial of 3,325 patients with CAP across seven Dutch hospitals. Eligible subjects were initially admitted to a non-ICU ward and treated with beta-lactam monotherapy (n=656), BLM (n=739), and fluoroquinolone monotherapy (n=888) patients were included.  

The primary endpoint was 90-day mortality, with a non-inferiority margin of 3% absolute difference. Secondary endpoints were time to oral treatment and length of stay. Baseline characteristics did not differ between study periods. S. pneumoniae was the most common pathogen (n=282; 12.4%) followed by H. influenzae (n=128; 5.6%), with L. pneumophilia only present in 0.7% of patients (n=16).

Beta-lactam monotherapy (9.0%, n=59) was non-inferior to BLM (11.1%, n=82) and fluoroquinolone monotherapy (8.8%, n=78) for 90-day mortality. Also, noninferiority of beta-lactam monotherapy was established for both arms in intention-to-treat analysis and in a sensitivity analysis of strategy adherent patients.

Median length of stay was 6 (4–8), 6 (4–10) and 6 (4–8) for beta-lactam monotherapy, BLM and fluoroquinolone monotherapy, respectively; median duration of IV treatment was 4 (3–5), 4 (3–5) and 3 (0–4) in the respective periods.

Empirical treatment with beta-lactam monotherapy for patients with CAP in non-ICU wards to proved non-inferior to BLM or fluoroquinolone monotherapy, the team concluded.  Beta-lactam monotherapy reduced atypical coverage by 46–52%, however “these results may not be generalizable to regions with a considerably different microbiological etiology of CAP,” added Dr. Postma.