Conference Correspondent

Oral Step-Down Therapy with Fluoroquinolones versus Beta-Lactams for Hospitalized Patients with Community-Acquired Pneumonia

Conference Correspondent - IDWeek 2018

In a retrospective cohort study, data were collected on non–intensive care unit patients admitted with community-acquired pneumonia at 46 Michigan hospitals. Patients were included if they received intravenous (IV) beta-lactam (BL; ceftriaxone or ampicillin-sulbactam) plus a macrolide or doxycycline by hospital day 2 and switched to an oral fluoroquinolone (FQ) or BL by therapy day 4. Exclusions included patients with positive culture, concomitant infection, healthcare-associated pneumonia, unstable on day 4, or severe immune deficiency.

Of 555 included patients, 54.4% were switched to an oral BL versus 45.6% who were switched to an oral respiratory FQ by day 4 of therapy. Both groups had similar duration of therapy (8 days), time to clinical stability, prior antibiotics, and chronic obstructive pulmonary disease, but the BL group was older, with a higher Pneumonia Severity Index, CURB-65, and more cardiovascular (CV) disease. In multivariate analysis, CV disease and higher CURB-65 were more common and diabetes mellitus (DM) was less common in the oral BL group. Sharing antibiotic use data with providers was associated with less FQ use. There were no differences in patient outcomes. Nearly half of the patients started on IV BL therapy were switched to an oral FQ by day 4, including more patients with DM, with significant variation among hospitals. Although the patients in the BL group were more likely to have cardiovascular disease and more severe pneumonia, there were no differences in outcomes between cohorts. Given the harms associated with FQ use and similar outcomes between CAP patients treated exclusively with BLs with or without atypical coverage as opposed to those transitioned to FQs, stewardship programs should emphasize transition from IV BL to non-FQ oral therapies in clinically stable patients with CAP.

Source: Petty L, et al. IDWeek 2018. Abstract 216.
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