Antibiotic Stewardship May Aid Stepdown Therapies in CAP

There were no differences in outcomes compared with patients receiving fluoroquinolone therapy.
There were no differences in outcomes compared with patients receiving fluoroquinolone therapy.
This article is part of MPR's coverage of IDWeek 2018, taking place in San Francisco, CA. Our on-site staff will be reporting on the latest breaking research and clinical advances in infectious diseases. Check back regularly for highlights from IDWeek 2018.

SAN FRANSISCO — The use of fluoroquinolones in stable patients with community-acquired pneumonia (CAP) can be reduced with the use of stewardship programs that share antibiotic use data and provide guidance for step-down therapy, according to new findings from a retrospective cohort study presented at ID Week 2018, held October 3-7 in San Francisco, California.

CAP guidelines recommend transitioning to an oral beta-lactam or fluoroquinolone regimen when patients are clinically stable, but because of common adverse effects, stewardship efforts are frequently focused on reducing initial fluoroquinolone use for CAP therapy. In this study the researchers hypothesized that the use of fluoroquinolones continues to be prevalent in treating CAP despite initial intravenous beta-lactam therapy, and examined factors associated with switching to oral beta-lactam vs a fluoroquinolone in 555 patients with CAP whose illness did not require admission to the intensive care unit.

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Data was collected during a 2-year period from 46 hospitals, and patients were included in the analysis if they received treatment with intravenous beta-lactam (ceftriaxone or ampicillin-sulbactam) plus macrolide/doxycycline by day 2 and then were switched to an oral fluoroquinolone or beta-lactam by day 4. More than half of the patients (54.4%) were switched to an oral beta-lactam vs 45.6% to a fluroquinolone by day 4.  Multivariable analysis showed that cardiovascular disease and higher CURB-65 Pneumonia Severity Calculator scores were more common in the oral beta-lactam cohort, but diabetes was less common. Lower fluoroquinolone use was associated with antibiotic selection data sharing among providers (83.1% vs 70.8%; odd ratio, .51; 95% CI, .27-.97; P =.04), but there were no differences in patient outcomes between the 2 groups.

“Although there were sicker patients in the oral beta-lactam group, there were no differences in outcomes between cohorts,” concluded the researchers.

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Reference

Petty L, Patel TS, Conlon A, et al. Step-down therapy with oral fluoroquinolones vs oral beta-lactams for hospitalized adult patients with community-acquired pneumonia: a multi hospital cohort study. Presented at: IDWeek 2018; October 3-7, 2018; San Francisco, California. Abstract 216.