Medline ® Abstracts for References 40-43
of 'Treatment of community-acquired pneumonia in adults who require hospitalization'
Guidelines and quality measures: do they improve outcomes of patients with community-acquired pneumonia?
Johnstone J, Mandell L
Infect Dis Clin North Am. 2013 Mar;27(1):71-86.
Community-acquired pneumonia (CAP) has a significant impact in terms of morbidity, mortality, and cost of care. Guidelines play an important role in the management of this disease, and evidence supporting the positive effects of guidelines on outcomes in patients with CAP is substantial. However, evidence supporting many of the CAP quality indicators is low, and pay-for-performance measures do not seem to influence clinically important outcomes. Future CAP quality indicators should incorporate evidence-based interventions.
Department of Medicine, McMaster University, West Hamilton, Ontario, Canada.
National Institute for Health and Care Excellence. Pneumonia: Diagnosis and management of community- and hospital-acquired pneumonia in adults. NICE guidelines, 2014. https://www.nice.org. uk/guidance (Accessed on February 14, 2016).
no abstract available
Oral gemifloxacin versus sequential therapy with intravenous ceftriaxone/oral cefuroxime with or without a macrolide in the treatment of patients hospitalized with community-acquired pneumonia: a randomized, open-label, multicenter study of clinical efficacy and tolerability.
Lode H, File TM Jr, Mandell L, Ball P, Pypstra R, Thomas M, 185 Gemifloxacin Study Group
Clin Ther. 2002;24(11):1915.
OBJECTIVE: This study aimed to compare the efficacy and safety of oral gemifloxacin, an enhanced-affinity quinolone, with sequential therapy with IV ceftriaxone followed by oral cefuroxime (with or without a macrolide) in patients hospitalized for community-acquired pneumonia (CAP).
METHODS: A randomized, open-label, multicenter study comprised adults hospitalized with a clinical and radiologic diagnosis of CAP. Patients were randomized 1:1 to receive either (1) oral gemifloxacin 320 mg once daily (7-14 days); or (2) IV ceftriaxone 2 g once daily (1-7 days) followed by oral cefuroxime 500 mg twice daily (1-13 days) for a total of<or = 14 days. Patients receiving ceftriaxone/cefuroxime were allowed concomitant macrolide treatment.
RESULTS: A total of 345 patients were randomized, of whom 341 received at least 1 dose of study medication (gemifloxacin, 169/172; ceftriaxone/cefuroxime, 172/173). Clinical success rates in the clinically evaluable (CE) population at follow-up (day 21-28 post-therapy), the primary end point, were 92.2% (107/116) for gemifloxacin and 93.4% (113/121) for ceftriaxone/cefuroxime (treatment difference, -1.15; 95% CI, -7.73 to 5.43). In patients in Fine risk classes IV and V, the clinical success rate was 87.0% (20/23) for gemifloxacin versus 83.3% (20/24) for ceftriaxone/cefuroxime. No difference in clinical response at follow-up was noted based on macrolide use. Bacteriologic success rates at follow-up in the bacteriologically evaluable (BE) population were 90.6% (58/64) for gemifloxacin and 87.3% (55/63) for ceftriaxone/cefuroxime (treatment difference 3.32; 95% CI, -7.57 to 14.21). The clinical success rate in bacteremic patients at follow-up (BE population) was 100.0%. Both treatments were generally well tolerated. The frequency and types of adverse events were similar between the 2 groups. The most common treatment-related adverse events with gemifloxacin were diarrhea, liver-function adverse events, and rash; with ceftriaxone/cefuroxime, they were diarrhea, elevated hepatic-enzyme activity, and moniliasis.
CONCLUSION: The clinical efficacy and tolerability of oral gemifloxacin 320 mg once daily were similar to those of IV ceftriaxone followed by oral cefuroxime (with or without a macrolide) in the treatment of adult patients hospitalized with moderate to severe CAP. Both treatments were effective in bacteremic patients and those at increased risk of mortality.
Department of Chest and Infectious Diseases, Hospital Heckeshorn, Akademisches Lehrkrankenhaus, Free University Berlin, Berlin, Germany. email@example.com
Does empirical therapy with a fluoroquinolone or the combination of aβ-lactam plus a macrolide result in better outcomes for patients admitted to the general ward?
Ruhe J, Mildvan D
Infect Dis Clin North Am. 2013 Mar;27(1):115-32. Epub 2012 Dec 1.
Community-acquired pneumonia (CAP) is a frequent cause of morbidity and mortality in the United States and worldwide, in particular among older patients and those with significant comorbid conditions. Current guidelines recommend therapy with a fluoroquinolone or aβ-lactam plus a macrolide for the treatment of hospitalized adults with CAP who do not require admission to an intensive care unit. This article provides a brief summary and overview of the existing literature on this topic categorized by the main results; the potential implications for future clinical practice and research are discussed.
Division of Infectious Diseases, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY 10003, USA. firstname.lastname@example.org