Antibiotic treatment patterns, costs, and resource utilization among patients with community acquired pneumonia: a US cohort study

ABSTRACT

Objectives: The current treatment options for patients with community-acquired pneumonia (CAP) often present a trade-off between the potential for treatment failure and safety concerns. We set out to investigate real-world outcomes associated with the use of currently available antimicrobial treatment options for CAP in both the outpatient and inpatient (non-intensive care unit [ICU]) settings.

Methods: This claims-based retrospective study included adult patients diagnosed with CAP and treated with antibiotic therapies, including any oral fluoroquinolone, macrolide, or beta-lactam monotherapy in the outpatient setting, and intravenous (IV) levofloxacin or IV azithromycin/ceftriaxone in the inpatient setting. Generalized linear model (GLM) regression was used to determine total charges for inpatient stay, the length of stay, and days of inpatient therapy. For outpatients, rates of adverse events (AEs), treatment failure, and hospitalization were compared by type of initial antibiotic therapy using logistic regression multivariate models that controlled for baseline characteristics.

Results: A total of 441,820 outpatients and 33,287 inpatients treated for CAP between 2007 and 2012 were included in this analysis. In the outpatient setting, fluoroquinolone therapy led to a higher rate of documented AEs (adjusted odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.20–1.25; p < 0.0001) but a lower rate of retreatment (adjusted OR: 0.9; 95% CI: 0.87–0.94; p < 0.0001) compared with macrolides. Both AEs and retreatment in these patients were associated with increased costs. For patients treated with the IV macrolide/beta-lactam combination compared with IV fluoroquinolone in the inpatient setting, a significantly longer length of stay in hospital (4.71 vs. 4.38 days; p < 0.0001) and greater overall costs ($3,535 more per stay; p < 0.0001) were observed.

Conclusion: In both the inpatient and outpatient settings, the development of additional efficacious treatment options that have a reduced AE burden for patients with CAP may be warranted.

KEYWORDS:

• Community-acquired pneumonia
• antibiotics
• fluoroquinolones
• macrolides
• beta-lactams
• inpatients
• outpatients

Acknowledgments

The authors take full responsibility for the content of the paper. They would like to thank Peter Classi, an employee of Cempra Pharmaceuticals, for his contributions to the study report. They also thank Analysis Group for medical writing support, editorial assistance, and collation and incorporation of comments from all authors.

Declaration of interest

G Tillotson is an employee of Cempra Pharmaceuticals and owns stock/stock options. C Llop and E Tuttle are employees of Analysis Group, Inc., which has received consultancy fees from Cempra Pharmaceuticals. K LaPlante has received grants from Merck, Pfizer, Davol/BARD, and The Medicines Company, and has served as a scientific advisor for Allergan and Cempra Pharmaceuticals. K LaPlante did not receive funding or payment for her contributions to this work. T File has nothing to disclose and did not receive funding or payment for his contributions to this work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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Additional information

Funding

This study was funded by Cempra Pharmaceuticals.