Comparative treatment failure rates of respiratory fluoroquinolones or β-lactam + macrolide versus β-lactam alone in the treatment for community-Acquired pneumonia in adult outpatients

An analysis of a nationally representative claims database

Meng Tse Gabriel Lee, Shih Hao Lee, Shy Shin Chang, Ya Lan Chan, Laura Pang, Sue Ming Hsu, Chien Chang Lee

Research output: Contribution to journalArticle

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Abstract

No comparative effectiveness study has been conducted for the following 3 antibiotics: respiratory uoroquinolone, b-lactam, and blactam + advanced macrolide. To gain insights into the real-world clinical effectiveness of these antibiotics for community-Acquired pneumonia in adult outpatients, our study investigated the treatment failure rates in 2 million representative participants from the National Health Informatics Project (NHIP) of Taiwan. A new-user cohort design was used to follow NHIP participants from January 2000 until December 2009. Treatment failure was defined by either one of the following events: a second antibiotic prescription, hospitalization due to CAP, an emergency department visit with a diagnosis of CAP, or 30-day nonaccident-related mortality. From 2006 to 2009, we identified 9256 newly diagnosed CAP outpatients, 1602 of whom were prescribed levofloxacin, 2100 were prescribed moxifloxacin, 5049 were prescribed β-lactam alone, and 505 were prescribed advanced macrolide +β-lactam. Compared with the β-lactam-based regimen, the propensity score-matched odds ratio for composite treatment failure was 0.81 (95% CI, 0.67-0.97) for moxifloxacin, 1.10 (95% CI, 0.90-1.35) for levofloxacin, and 0.95 (95% CI, 0.67-1.35) for macrolide +β-lactam. Moxifloxacin was associated with lower treatment failure rates compared with β-lactam alone, or levofloxacin in Taiwanese CAP outpatients. However, due to inherent limitations in our claims database, more randomized controlled trials are required before coming to a conclusion on which antibiotic is more effective for Taiwanese CAP outpatients. More population-based comparative effectiveness studies are also encouraged and should be considered as an integral piece of evidence in local CAP treatment guidelines.

Original languageEnglish
Pages (from-to)e1662
JournalMedicine (United States)
Volume94
Issue number39
DOIs
Publication statusPublished - Jan 1 2015
Externally publishedYes

Fingerprint

Lactams
Fluoroquinolones
Macrolides
Respiratory Rate
Treatment Failure
Pneumonia
Outpatients
Databases
Levofloxacin
Anti-Bacterial Agents
Informatics
Therapeutics
Propensity Score
Health
Taiwan
Prescriptions
Hospital Emergency Service
Hospitalization
Randomized Controlled Trials
Odds Ratio

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Comparative treatment failure rates of respiratory fluoroquinolones or β-lactam + macrolide versus β-lactam alone in the treatment for community-Acquired pneumonia in adult outpatients : An analysis of a nationally representative claims database. / Lee, Meng Tse Gabriel; Lee, Shih Hao; Chang, Shy Shin; Chan, Ya Lan; Pang, Laura; Hsu, Sue Ming; Lee, Chien Chang.

In: Medicine (United States), Vol. 94, No. 39, 01.01.2015, p. e1662.

Research output: Contribution to journalArticle

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abstract = "No comparative effectiveness study has been conducted for the following 3 antibiotics: respiratory uoroquinolone, b-lactam, and blactam + advanced macrolide. To gain insights into the real-world clinical effectiveness of these antibiotics for community-Acquired pneumonia in adult outpatients, our study investigated the treatment failure rates in 2 million representative participants from the National Health Informatics Project (NHIP) of Taiwan. A new-user cohort design was used to follow NHIP participants from January 2000 until December 2009. Treatment failure was defined by either one of the following events: a second antibiotic prescription, hospitalization due to CAP, an emergency department visit with a diagnosis of CAP, or 30-day nonaccident-related mortality. From 2006 to 2009, we identified 9256 newly diagnosed CAP outpatients, 1602 of whom were prescribed levofloxacin, 2100 were prescribed moxifloxacin, 5049 were prescribed β-lactam alone, and 505 were prescribed advanced macrolide +β-lactam. Compared with the β-lactam-based regimen, the propensity score-matched odds ratio for composite treatment failure was 0.81 (95{\%} CI, 0.67-0.97) for moxifloxacin, 1.10 (95{\%} CI, 0.90-1.35) for levofloxacin, and 0.95 (95{\%} CI, 0.67-1.35) for macrolide +β-lactam. Moxifloxacin was associated with lower treatment failure rates compared with β-lactam alone, or levofloxacin in Taiwanese CAP outpatients. However, due to inherent limitations in our claims database, more randomized controlled trials are required before coming to a conclusion on which antibiotic is more effective for Taiwanese CAP outpatients. More population-based comparative effectiveness studies are also encouraged and should be considered as an integral piece of evidence in local CAP treatment guidelines.",
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