Implementation of severity guided antibiotic treatment according to Dutch guidelines in hospitalized patients with community-acquired pneumonia (CAP) included in a clinical trial
Abstract
The aim of this study was to evaluate the use of antibiotics according to the Dutch guideline in patients with CAP included in a clinical trial with respect to clinical outcome at day 30. Antibiotic therapy was based on severity scoring of CAP next to clinical judgment.
A total of 213 patients were evaluated. Amoxicillin (122 patients, 57.3%) was most often prescribed (CURB-65 0-2: 82.8%; CURB-65 3-5: 17.2%), followed by moxifloxacin (80 patients, 37.6%) (CURB-65 0-2: 61.3%; CURB-65 3-5: 38.8%) and amoxicillin/clavulanic acid (9 patients, 4.2%) (CURB-65 0-2: 77.8%; CURB-65 3-5: 22.2%). 30 day mortality was 12 (5.6%) patients, 4 patients on initial amoxillin and 8 patients on initial moxifloxacin.
Patients on amoxicillin had a clinical success rate at day 30 of 80.0%, while patients on moxifloxacin had a clinical success rate of 61.3%.
In 20 (9.4%) patients antibiotic treatment was narrowed, whereas 7 (3.3%) patients were treated with broader spectrum antibiotics; 186 (87.3%) patients remained on their initial antibiotics.
In a multivariate analysis only severe CAP (CURB-65 score >2) was associated with clinical failure at day 30 (OR 6.0, 95% CI 2.1-17.5), while type of antibiotics, antibiotic change (narrowing of broadening) and aetiology were not associated with treatment failure.
Conclusion:
Patients with non-severe CAP can safely be treated with amoxicillin. The use of Dutch guideline concordant antibiotics resulted in a low rate of broadening antibiotic treatment.…
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