We studied differences in symptom course and process of care between pneumonia patients treated with gatifloxacin vs clarithromycin with ceftriaxone added for patients having 3 or more risk factors.
We measured time to return to usual activities, pneumonia specific symptom scores, and SF12 over 7 interviews ending 42 days. We used an open label, randomized design to determine if the different antibiotics changed likelihood of hospitalization. The study sites were the LDS hospital Emergency Department and 4 urgent care centers in Salt Lake City, and the Emergency Department and 3 rural outpatient clinics in Sanpete Valley, Utah.
We enrolled 266 patients over age 18 with radiographically confirmed pneumonia between September 2000 and June 2003. Mean age was 53.7 ± 19.6 years, 54% were female. Mean number of pneumonia risk factors was 1.5 ±1.5 and was similar in both groups. 64% of patients were class 1 by PSI, 22% class 2, 9% class 3, and 5% class 4. 91% of patients completed at least 5 of the 7 symptom interviews, and 88% completed the last interview at 42 days post-enrollment. 64% of patients randomized to clarithromycin received at least one dose of ceftriaxone. We found no significant difference between groups in time to return to usual activities, pneumonia specific symptom scores, and SF12. Of individual symptoms examined, only bad taste differed between the 2 groups, more common in clarithromycin patients. Hospital admission rate was not statistically different. Cost of therapy was less for gatifloxacin monotherapy, US$ 100 versus 257.
Gatifloxacin monotherapy is equivalent to clarithromycin ±ceftriaxone for treatment of pneumonia in symptom resolution and admission rate. Liberal use of combination therapy in the clarithromycin group may have masked outcome differences.
While the two drug regimens produce similar clinical outcomes, gatifloxacin monotherapy is less expensive.
N.C. Dean, This study was funded by a grant from Bristol Myer