Reviewed by Sara Karaba, MD, PhD, MHS, Johns Hopkins University
Bottom line: The comparative efficacy of different oral antibiotic regimens for community acquired pneumonia (CAP) is not clear, though this study by Butler and colleagues does demonstrate increased risk of adverse drug events (ADEs) among patient who received broad therapy as compared to narrow therapy, emphasizing that antibiotic selection should balance benefits and risks.
Previously, little was known regarding the comparative safety of antibiotic regimens for treatment of community-acquired pneumonia. In a large database study otherwise healthy adults age 18-64 with CAP, broad-spectrum regimens (fluoroquinolone, beta-lactam, or beta-lactam+macrolide) were each associated with increased adverse drug events compared to azithromycin monotherapy. These included nausea/vomiting/abdominal pain, non-C. difficile diarrhea, and vulvovaginal candidiasis. This study highlights an important role for antimicrobial stewardship in the outpatient setting, to decrease use of broad-spectrum antibiotics and thus also adverse drug events.
Reference: Butler AM, Nickel KB, Olsen MA, Sahrmann JM, Colvin R, Neuner E, O’Neil CA, Fraser VJ, Durkin MJ. Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults. Clin Infect Dis. 2024 Oct 23:ciae519. doi: 10.1093/cid/ciae519. Epub ahead of print. PMID: 39442057.