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Macrolide de-escalation a reasonable antimicrobial stewardship approach for severe CAP

29 Nov 2019

An antimicrobial stewardship approach of de-escalating from combination therapy with beta-lactam plus macrolide to beta-lactam monotherapy in the management of patients with severe community-acquired pneumonia (CAP) and a negative BioFire FilmArray Respiratory Panel 2 polymerase chain reaction (BioFire PCR) result is reasonable and does not lead to increased in-hospital mortality, according to a recent study.

Instead, de-escalation is associated with decreased length of stay (LOS) in the hospital and intensive care unit (ICU).

The study included 94 critically ill adults with CAP treated for ≥48 hours with combination beta-lactam and azithromycin therapy. Treatment was subsequently de-escalated to beta-lactam monotherapy in 53 patients and was retained in 41 patients.

In-hospital mortality did not significantly differ between the de-escalation and control group (2.4 percent vs 11.3 percent, respectively; p=0.312). However, patients in the de-escalated group had shorter ICU (1.9 vs 3.4 days; p=0.029) and hospital LOS (6 vs 7 days; p=0.025).

Likewise, there were no significant differences observed with respect to additional secondary endpoints, including duration of mechanical ventilatory support, 30-day readmission and incidence of azithromycin-related adverse effects.

Simple logistic regression confirmed that there was no association between de-escalation and hospital mortality (odds ratio, 0.17, 95 percent confidence interval [CI], 0.02–1.70).

“Our results suggest that macrolide de-escalation in the setting of a negative BioFire PCR result may be a reasonable approach to antimicrobial stewardship in the severe CAP population; however, larger, prospective studies are warranted to fully explain this association,” the researchers said.

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Most Read Articles
Pearl Toh, 4 days ago
Gefapixant, a first-in-class non-narcotic, oral P2X3 receptor antagonist, significantly reduces cough frequency in patients with refractory or unexplained chronic cough, according to two COUGH* studies presented at ERS 2020.
Roshini Claire Anthony, 18 Jul 2020

The concurrent occurrence of diabesity and COVID-19 may lead to more severe disease due to the latter, according to a presentation at the Opening Session of ENDO Online.

Pearl Toh, 18 Jan 2020
Almost three-quarters of adverse events (AEs) related to medication errors in over-the-counter (OTC) cough and cold medications (CCMs) for paediatrics required evaluation by healthcare facility and majority of the cases were due to dosing errors, a surveillance study has found, highlighting the need for interventions to mitigate medication errors.
Pearl Toh, 6 days ago
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