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James E. Stahl, MD; Michael Barza, MD; Jeffrey DesJardin, MD; Rhonda Martin, RN; Mark H. Eckman, MD

Arch Intern Med. 1999;159:2576-2580.

Background  The choice of antibiotics to treat community-acquired pneumonia (CAP) is primarily empiric, and the effect of this choice on length of stay (LOS) and mortality is largely unknown.

Objective  To examine the impact of antibiotic choice on these outcomes in general medical patients hospitalized with CAP.

Methods  One hundred patients hospitalized with CAP were prospectively identified. Seventy-six met inclusion criteria and were entered into the study. After hospital discharge, each medical chart was examined by 2 independent physicians who verified the admitting diagnosis and entered the data for antimicrobial regimens, a CAP mortality prediction tool, a social and disposition index, and other health outcomes. Patients were stratified according to the antibiotic received. Simple regression techniques were used to examine the correlation between initial therapy, specifically, ceftriaxone sodium or a macrolide, and LOS and mortality.

Results  Patients who received macrolides within the first 24 hours of admission had a markedly shorter LOS (2.8 days) than those not so treated (5.3 days; P=.01). This effect diminished as the interval before administering macrolides increased. Including ceftriaxone as part of the initial therapy did not appear to affect LOS. Patients given a macrolide for initial treatment did not differ significantly from those not treated in terms of mean age, mortality prediction tool score, or Social and Disposition Index score. Eleven of the 12 patients who received macrolides also received a -lactam antibiotic.

Conclusion  Use of macrolides as part of an initial therapeutic regimen appears to be associated with shorter LOS.

From the Divisions of Clinical Decision Making (Drs Stahl and Eckman), Informatics and Telemedicine (Drs Stahl and Eckman), Geographic Medicine and Infectious Diseases (Drs Barza and DesJardin), General Medicine (Drs Stahl and Eckman), and Quality Support Services (Ms Martin), Department of Medicine, New England Medical Center and Tupper Research Institute, Tufts University School of Medicine, Boston, Mass.

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