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Azithromycin Monotherapy for Patients Hospitalized With Community-Acquired Pneumonia
A 3 -Year Experience From a Veterans Affairs Hospital
Randy B. Feldman, MD;
David C. Rhew, MD;
John Y. Wong, BS;
Robert Antoine Charles, PharmD, MS;
Matthew Bidwell Goetz, MD
Arch Intern Med. 2003;163:1718-1726.
Background Current American Thoracic Society (ATS) community-acquired pneumonia treatment guidelines recommend azithromycin monotherapy for a limited subset of hospitalized patients. We evaluated the effectiveness of azithromycin monotherapy in a more generalized population of patients hospitalized with mild-to-moderate community-acquired pneumonia.
Methods We reviewed medical records from a Veterans Affairs facility for patients admitted with community-acquired pneumonia between December 1, 1997, and June 30, 2001, comparing those receiving azithromycin monotherapy, other ATS-recommended antibiotics, and non–ATS-recommended antibiotics. We excluded patients with immunosuppression, metastatic cancer, or hospital-acquired pneumonia. Outcome measures included times to stability, meeting criteria for change to oral therapy, and eligibility for discharge; length of stay; intensive care unit transfer; and mortality. Outcomes were adjusted for pneumonia severity, skilled nursing facility status, and processes of care.
Results A total of 442 patients were eligible for the study (221 in the azithromycin monotherapy group, 129 in the ATS group, and 92 in the non-ATS group). Times to clinical stability and to fulfilling early switch criteria were not statistically significantly different among the 3 groups. Mean time to fulfilling early discharge criteria was 2.48 days for patients receiving azithromycin monotherapy vs 2.84 days for those receiving ATS antibiotics (P = .008) and 2.58 days for those receiving non-ATS antibiotics (P = .64). Overall mean length of stay was shorter in the azithromycin monotherapy group (4.35 days) vs the ATS (5.73 days) (P = .002) and non-ATS (6.21 days) (P<.001) groups. Mortality, intensive care unit transfer, and readmission rates were similar across the groups.
Conclusion Azithromycin monotherapy is equally as efficacious as other ATS-recommended regimens for treating hospitalized patients with mild-to-moderate community-acquired pneumonia.
From the Division of Infectious Diseases, the VA Greater Los Angeles Healthcare System, Los Angeles, Calif (Drs Feldman, Rhew, and Goetz); Zynx Health Inc, Cedars-Sinai Health System Department of Health Services Research, Beverly Hills, Calif (Dr Rhew and Messrs Wong and Charles); and Department of Medicine, The David Geffen School of Medicine at UCLA, Los Angeles (Drs Feldman, Rhew, and Goetz). The authors have no relevant financial interest in this article.
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