Empiric Meropenem-based versus Ceftazidime-based Therapy for Severe Community-Acquired Pneumonia in a Retrospective Cohort Study
Abstract
Dear Editor, Optimal antibiotic regimen is unknown for severe community-acquired pneumonia (SCAP) which has mortality rates of up to 67% locally.1 Recommended empiric regimens from the West cannot be extrapolated to our region where melioidosis is endemic2 and Streptococcus pneumoniae penicillin resistance is common.3 Unfortunately, studies that compare optimal antibiotic regimens for SCAP in Southeast Asia are lacking. Considering local epidemiology, our hospital’s guidelines recommended ceftazidime as empiric therapy for SCAP due to its activity against Burkholderia pseudomallei. To complement its poorer activity against S. pneumoniae,4 levofloxacin or moxifloxacin was added for pneumococcal and atypical coverage. However, physicians could deviate from the guidelines and use meropenem with a macrolide instead. Anecdotally, we observed higher mortality rates in patients on empiric ceftazidime-based regimen. Hence, this retrospective study was conducted with a primary objective of comparing 30-day all-cause mortality between the 2 regimens.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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