Nearly one-quarter of adults prescribed antibiotics as a first line treatment for community-acquired pneumonia were non-responsive to the medications, a new study revealed. Current guidelines for community-acquired pneumonia, published by the American Thoracic Society and the Infectious Disease Society of America in 2007, offer insight on the disease. However, researchers noted that large-scale, real-world data were needed to gain greater knowledge of antibiotic choices and to better evaluate risk factors that may stem from treatment failure.
As part of the study, a team of researchers looked at databases with records of nearly 252,000 adult patients treated between 2011 and 2015. The patients received a single class of antibiotics — such as beta-lactam, macrolide, tetracycline, or fluoroquinolone — following a health care visit for community-acquired pneumonia. The scientists defined treatment failure based on the following factors: antibiotic refill, antibiotic switch, emergency department visit, and 30-day hospitalization following initial antibiotic prescription.
The study revealed that the total antibiotic failure was 22.1 percent. The research team also found that older patients and those with preexisting co-morbid conditions had higher rates of drug failure. The scientists were also able to determine failure rates based on the class of antibiotics used. According to the study, the failure rates for beta-lactam users was 25.7 percent, while macrolide users had a failure rate of 22.9 percent. In addition, the failure rates for tetracycline users was 22.5 percent, while fluoroquinolone users had a failure rate of 20.8 percent.
“Pneumonia is the leading cause of death from infectious disease in the United States, so it is concerning that we found nearly one in four patients with community-acquired pneumonia required additional antibiotic therapy, subsequent hospitalization or emergency room evaluation. The additional antibiotic therapy noted in the study increases the risk of antibiotic resistance and complications like C. difficile (“C diff”) infection, which is difficult to treat and may be life-threatening, especially for older adults,” lead author Dr. James A. McKinnell said in ScienceDaily.com.
“Our findings suggest that the community-acquired pneumonia treatment guidelines should be updated with more robust data on risk factors for clinical failure. Our data provide numerous insights into characteristics of patients who are at higher risk of complications and clinical failure. Perhaps the most striking example is the association between age and hospitalization: Patients over the age of 65 were nearly twice as likely to be hospitalized compared to younger patients when our analysis was risk adjusted and nearly three times more likely in unadjusted analysis. Elderly patients are more vulnerable and should be treated more carefully, potentially with more aggressive antibiotic therapy,” Dr. McKinnell added.
The lead author also noted that the study identified substantial regional differences in treatment outcomes, which were not addressed in the community-acquired pneumonia guidelines published 10 years ago. The study also revealed that patients with comorbid conditions — such as chronic obstructive pulmonary disease, cancer, or diabetes — were not prescribed combination antibiotic treatments as indicated in the guidelines.
The findings were presented at the 2017 American Thoracic Society International Conference.
Pre-penicillin era may just be around the corner
In line with the recent findings, health ministers of the G20 leading economies cautioned that the world may return to a pre-penicillin era as antibiotic resistance continues to worsen. According to the World Health Organization (WHO), antibiotic resistance has become one of the biggest threats to global health. The organization noted that an increasing number of infections such as pneumonia, tuberculosis, blood poisoning, and gonorrhea have become more difficult to manage using antibiotic treatment. (Related: Read more news about superbug treatments at Superbugs.news)
Just last year, a report from the European Union (EU) revealed that antibiotics resistance accounted for more than 25,000 deaths per year in the region. In line with this, the G20 health ministers assented on the implementation of national action plans by the end of 2018 in order to combat the worsening cases of antibiotic resistance. (Related: Antibiotic alternatives you need to know today)
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