23 Sept 2023 • Adults with nonsevere community-acquired pneumonia (CAP) responded nearly equally to three first-line and alternative antibiotic regimens, based on data from more than 23,000 individuals. In a study published in Chest, the researchers reviewed data from 23,512 consecutive patients admitted to 19 hospitals in Canada for CAP between 2015 and 2021.

Patients were treated with one of four initial antibiotic regimens:

• beta-lactam plus macrolide (BL+M)
• beta-lactam alone (BL)
• respiratory fluoroquinolone (FQ)
• or beta-lactam plus doxycycline (BL+D).

Of these, BL+M is generally considered the first-line regimen, the researchers noted.

The overall results support dropping BL as a first-line regimen in the current ATS/IDSA guidelines, and support the recommendation of BL+M, FQ, and BL+D as similarly effective options as listed in other guidelines. Based on this study, clinicians may choose a respiratory fluoroquinolone, a beta-lactam plus macrolide, or a beta-lactam plus doxycycline for equally effective antibiotic treatment of CAP, based on the best fit for each individual patient, the researchers concluded.

BL was associated with longer time to discharge and the CI for mortality cannot exclude a small but clinically important increase in risk.

Source: CHEST | Read full story