Conference Correspondent

Longer Duration of Antibiotic Therapy for Community-Acquired Pneumonia and Risk for Clostridium Difficile Infection

Conference Correspondent - IDWeek 2018

A recent study showed that the median length of antibiotic therapy (LOT) for uncomplicated community-acquired pneumonia was 9.5 days,1 which is at odds with the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines that call for a minimum of 5 days of therapy, with 7 or more days rarely necessary.2 Researchers conducted a retrospective cohort study, including Medicare beneficiaries with parts A, B, and D hospitalized with uncomplicated community-acquired pneumonia for 2 to 10 days.3

The cohort consisted of 99,883 patients, aged ≥65 years. The median total LOT was 9.5 days (interquartile range, 7.4-11.4). Antibiotics filled at discharge included quinolones (40%), none (20%), multiple (14%), cephalosporins (10%), macrolides (7%), and beta-lactam–beta-lactamase inhibitor combinations (5%). Risk for Clostridium difficile infection (CDI) was 1.2%. Overall adjusted risk among those with longer LOT (>9.5 days) was 1.2 (95% [confidence interval, 1-1.14) times that of those with shorter LOT (≤9.5 days). Increased risk was observed among those prescribed quinolones at discharge (adjusted CDI risk for longer LOT was 1.4 [95% CI, 1.2-1.7]) compared with those prescribed shorter LOT. CDI risk increased by 4% per added day of antibiotic use. Patients with a longer LOT had a 20% increase in CDI risk and a 40% increased risk with quinolones filled at discharge. Shorter LOT may have been preventive in 1 of 5 CDI cases.

By increasing compliance with the IDSA/ATS guidelines that recommend shortening LOT, the risk for CDI in patients hospitalized with community-acquired pneumonia can be reduced, especially in those treated with fluoroquinolones at discharge.

References

  1. Yi SH, et al. Clin Infect Dis. 2018;66:1333-1341.
  2. Mandell LA, et al. Clin Infect Dis. 2007;44(Suppl 2):S27-S72.
  3. Yi SH, et al. IDWeek 2018. Abstract 519.
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Last modified: October 5, 2018
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