Antibiotic Treatment Strategies for CAP
The Article: Antibiotic Treatment Strategies for Community Acquire Pneumonia in Adults Douwe F. Postma et al. New Engl J Med. 2015 April 2.
The Idea: Comparing beta lactam monotherapy versus beta lactam plus azithromycin or fluoroquinolone monotherapy in patients hospitalized in wards for CAP.
The Study: Non-inferiority trial with 2283 hospitalized patients who were cluster randomized to receiving one of the three treatment strategies for CAP: 1. Beta lactam monotherapy 2. Beta lactam plus macrolide 3. Fluoroquinolone monotherapy
The Results: Beta lactam monotherapy is not inferior to beta lactam plus macrolide or fluoroquinolone monotherapy for the treatment for patients hospitalized for CAP in non-ICU settings. The authors found no different in all cause 90-day mortality or hospital complications.
The Take Away: Although this study suggests beta lactam monotherapy to be non inferior to our current antibiotic practices, one should be careful using that strategy as we will no longer be treating for atypical bacteria that cause PNA. Mortality rates have gone down since we have started treating with macrolides and fluoroquinolones. Several large studies have also validated our current antibiotic practices and resistance patterns of strep pneumonia to beta lactam in America are different from Netherlands. Therefore, we may need further validation prior to changing our current antibiotic choices.