Abstract
Purpose: Patients with chronic obstructive pulmonary disease (COPD) have an increased incidence of pneumonia caused by Pseudomonas aeruginosa. A respiratory fluoroquinolones alone or a beta-lactam plus a macrolide is recommended in the presence of comorbidities according to Infectious Diseases Society of America/American Thoracic Society guideline for community-acquired pneumonia. However, few studies have directly compared the two regimens. The present study aimed to compare the risk of pneumonia-related hospitalization in COPD patients treated with fluoroquinolones versus b-lactam/b-lactamase inhibitor combinations. Methods: We conducted a retrospective cohort study and identified 19,876 episodes of COPD with pneumonia in the outpatients from the Taiwan National Health Insurance Research Database (NHIRD) during 2002e2011. Using the propensity score analysis, patients receiving fluoroquinolones and b-lactam/b-lactamase inhibitor combinations were matched for baseline covariates (n Z 1,296 episodes for each groups). The primary outcome was pneumonia-related hospitalization more than 3 days after receiving antibiotics, while the secondary outcomes were treatment failure, 30-day mortality and medical costs. Results: The rate of pneumonia-related hospitalization was 3.9% in the fluoroquinolone group and 3.5% in the b-lactam/b-lactamase inhibitor combination group (adjusted hazard ratio [HR], 1.11; 95% confidence interval [CI], 0.74e1.66). Compared with b-lactam/b-lactamase inhibitor combinations, fluoroquinolones did not offer less treatment failure (28.2% vs. 31.3%; HR, 0.86; 95% CI, 0.73e1.02) and 30-day mortality (0.5% vs. 0.4%; HR, 1.40; 95% CI, 0.45e4.41). The total medical costs (15,847 vs. 13,644 Taiwan dollars) and pneumonia-related costs (6,060 vs. 4,646 Taiwan dollars) were similar between these two groups (both P > 0.05). Conclusions: InCOPDoutpatientswithpneumonia,fluoroquinoloneswereassociated with similar outcomes compared with b-lactam/b-lactamase inhibitor combinations. Our findings supported the current consensus recommendations.
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