Abstract
BackgroundStudies on the association between antibiotic treatment and outcomes in outpatients with chronic obstructive pulmonary disease (COPD) and pneumonia are scarce. This study aimed to evaluate the effectiveness of fluoroquinolones and β-lactam/β-lactamase inhibitors for pneumonia in COPD outpatients.MethodsWe conducted a retrospective cohort study and identified 4,851 episodes of pneumonia among COPD outpatients treated with fluoroquinolones or β-lactam/β-lactamase inhibitors from the Taiwan National Health Insurance Research Database during 2002–2011. Using the propensity score analysis, 1,296 pairs of episodes were matched for the demographic and clinical characteristics. The primary outcome was pneumonia/empyema-related hospitalization or emergency department (ED) visits, and the secondary outcomes were treatment failure, all-cause mortality and medical costs within 30 days.ResultsCompared with episodes treated with β-lactam/β-lactamase inhibitors, episodes treated with fluoroquinolones had similar clinical outcomes. The rates of pneumonia/empyema-related hospitalization or ED visits were 3.9% and 3.5% in the fluoroquinolone and β-lactam/β-lactamase inhibitor groups, respectively (adjusted hazard ratio [aHR], 1.11; 95% confidence interval [CI], 0.74–1.66). The percentage of treatment failure and all-cause mortality were 28.2% versus 31.3% (adjusted odds ratio, 0.86; 95% CI, 0.73–1.02) and 0.5% versus 0.4% (aHR, 1.40; 95% CI, 0.45–4.41) in the fluoroquinolone and β-lactam/β-lactamase inhibitor groups, respectively. The medical expenditures, including total medical costs (528 versus 455 US dollars) and pneumonia-related costs (202 vs. 155 USD) were also balanced between the two treatment groups (both P >0.05).ConclusionsFor pneumonia in COPD outpatients, fluoroquinolones were associated with similar clinical outcomes and medical expenditures compared with β-lactam/β-lactamase inhibitors.
Highlights
Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide [1], and projected to become the fourth leading cause of death and the seventh cause of the global burden of disease by 2030 [2]
Compared with episodes treated with β-lactam/β-lactamase inhibitors, episodes treated with fluoroquinolones had similar clinical outcomes
The percentage of treatment failure and all-cause mortality were 28.2% versus 31.3% and 0.5% versus
Summary
Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide [1], and projected to become the fourth leading cause of death and the seventh cause of the global burden of disease by 2030 [2]. The increased risk of pneumonia in COPD patients results from parenchymal destruction, chronic inflammation, and treatment with inhaled corticosteroids [5,6]. The choice of antibiotic treatment for pneumonia among the COPD population is different from other populations in consideration of the diverse microbiological pattern and bacterial resistance. Current Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) treatment guidelines for pneumonia recommend a respiratory fluoroquinolone or combination of a β-lactam and a macrolide in outpatients with comorbidities or risks for acquiring resistant microorganisms [7,8]. Studies on the association between antibiotic treatment and outcomes in outpatients with chronic obstructive pulmonary disease (COPD) and pneumonia are scarce. This study aimed to evaluate the effectiveness of fluoroquinolones and β-lactam/β-lactamase inhibitors for pneumonia in COPD outpatients
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