β-Lactam monotherapy vs β-lactam-macrolide combination treatment in moderately severe community-acquired pneumonia: a randomized noninferiority trial.
Summary of articles
- It is open-label, multicenter, randomized trial study
- Purpose of this study: to compare a β-lactam alone compared with a β-lactam and macrolide combination in management of community-acquired pneumonia
- Method: 580 patients with community acquired pneumonia
- Monotherapy group: 291 patients with cefuroxime or augmentin
- Combination group: 289 patients with clarithromycin plus cefuroxime or augmentin
- Outcomes
Both groups are followed
Primary outcomes: proportion of patient NOT reach clinical stability in 7 days treatment
Secondary outcomes: 30 days, 90 days mortality, transfer to ICU, length of stay, readmission, recurrence of pneumonia, the need to add new antibiotics, and pleural effusion
Results:
Primary outcomes results: the monotherapy group has 120/291, 41.2% patients are not clinically stable; and the combination group has 97/289, 33.6% patients are not clinically stable
Secondary outcome results: there are no significant difference between these two groups in 30 days, 90 days mortality, transfer to ICU, length of stay, readmission, recurrence of pneumonia, the need to add new antibiotics, and pleural effusion
- Conclusion
Beta-lactam monotherapy is not inferior to combination therapy in patients are hospitalized for community acquired pneumonia
- Relating to my patient
My patient, Mrs. K is a 69 years old female who has 1-month history of productive cough, SOB, chest pain, rhonchi. She is diagnosed with RLL pneumonia and admitted to hospital for further observation and management. In the hospital she was given ceftriaxone and then changed to macrolide. According to this article, my patient can be put on monotherapy, which is also effective for pneumonia.
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