Most Read Articles
Stephen Padilla, 6 days ago
A wearable, hermetically sealed high-precision vibration sensor enables simultaneous monitoring of multiple health factors associated with the cardiopulmonary system, including heart and respiratory rates, heart sounds, lung sounds, and body motion and position of an individual, a study shows.
Tristan Manalac, 14 Feb 2020
The use of e-cigarettes with flavoured juices for weight-related reasons appears to be common among adolescents, according to a new study.
Pearl Toh, 04 Feb 2020
Four months of daily rifampicin is safer than 9 months of daily isoniazid when it comes to treating latent tuberculosis (TB) infection, according to a post hoc safety analysis on pooled data from two randomized studies* — thus rendering the ambitious goal by the WHO to treat 30 million patients possible.

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.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Stephen Padilla, 6 days ago
A wearable, hermetically sealed high-precision vibration sensor enables simultaneous monitoring of multiple health factors associated with the cardiopulmonary system, including heart and respiratory rates, heart sounds, lung sounds, and body motion and position of an individual, a study shows.
Tristan Manalac, 14 Feb 2020
The use of e-cigarettes with flavoured juices for weight-related reasons appears to be common among adolescents, according to a new study.
Pearl Toh, 04 Feb 2020
Four months of daily rifampicin is safer than 9 months of daily isoniazid when it comes to treating latent tuberculosis (TB) infection, according to a post hoc safety analysis on pooled data from two randomized studies* — thus rendering the ambitious goal by the WHO to treat 30 million patients possible.