To compare the mortality rate (as a primary outcome) and the rates of clinical response, complication and length of hospital stay (as secondary outcomes) between the group receiving third generation non-pseudomonal cephalosporin alone with the group receiving additional combined a new IV/oral macrolide for the treatment of severe community-acquired pneumonia.
An open-blinded, randomized controlled study was conducted prospectively among the admitted patients diagnosed as severe community-acquired pneumonia by using ATS and BTS criteria during 1 August 2001-31 July 2002 period (n=110). The third generation non-pseudomonal cephalosporin (ceftriazone of cefotaxime) was used conventionally to treat these groups of patients who the etiologic agents were initially unknown. The additional IV/Oral macrolide(clarithromycin) was administered randomly by the investigating nurse. The Chi-square test and student t-test was a statistical mean using for comparisons the differences of the clinical outcomes between the two groups.
Although, the overall mortality rate of the group receiving the new macrolide combined in the regimen and the group receiving third generation cephalosporin alone was not statistically difference (23.33% vs. 37.84%, p=0.203), but the CAP-related mortality of the former group was significantly lower than the latter one (6.67 % vs. 29.73 %, p=0.018). All the secondary outcomes of the former were significantly better than the latter (the rates of initial response and CAP-related complication were 96.67 % vs. 70.27 %, p=0.005; 22.22% vs 80%, p=0.023, respectively) except the mean length of hospital stay tended to be shorter for 4 day in the former but this didn’t reach statistical difference [12.27(5-30) days vs. 16.74(5-43) days, p=0.091].
The severe community-acquired pneumonic patients receiving the initial combination of the third generation non-pseudomonal cephalosporin and a new macrolide antibiotic had much better clinical outcomes including: lower CAP-related mortality and complications; higher initial response and cure; lower initial deterioration and tended to have a shorter length of hospital stay.
Initial combination of third generation cephalosporin and new macrolide can improve severe community-acquired pneumonia related-outcomes.
C. Pothirat, None.