Exclusive oral antibiotic treatment for hospitalized community-acquired pneumonia: a post-hoc analysis of a randomized clinical trial
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Dinh, Aurélien | Duran, Clara | Matt, Morgan | Mellon, Guillaume | Calin, Ruxandra Oana | Makhloufi, Sabrina | Ropers, Jacques | Bouchand, Frédérique | Deconinck, Laurène | Senard, Olivia | Lagrange, Aurore | de Lastours, Victoire | Mathieu, Emmanuel | Kahn, Jean Emmanuel | Rouveix, Elisabeth | Grenet, Julie | Dumoulin, Jennifer | Chinet, Thierry | Pépin, Marion | Delcey, Véronique | Diamantis, Sylvain | Benhamou, Daniel | Vitrat, Virginie | Dombret, Marie Christine | Renaud, Bertrand | Claessens, Yann Erick | Labarère, José | Bedos, Jean Pierre | Aegerter, Philippe | Crémieux, Anne Claude | Attal-Behar, Julie | Beaune, Sébastien | Thierry Chinet, Null | Cudennec, Tristan | de Laroche, Marine | de Thezy, Albane | Dupont, Caroline | Fercot, Elise | Giraut, Violaine | Greffe, Ségolène | Guyot, Caroline | Labrune, Sylvie | Lachatre, Marie | Moulias, Sophie | Naline, Charlotte | Sahut-D Izarn, Marine | Sefssafi, Abel | Teillet, Laurent | Bru, Jean Pierre | Gaillat, Jacques | Gautier, Vincent | Janssen, Cécile | Pagani, Leonardo | Abderrahmane, Malika | Camuset, Juliette | Legall, Catherine | Longuet-Flandres, Pascale | Menn, Anne Marie | Prevost, Gwenolée | Lecronier, Marie | Burdet, Charles | Derradji, Ouda | Escaut, Lelia | Hinglais, Etienne | Lebras, Philippe | Lefevre, Edouard | Noaillon, Mathilde | Rabier, Pauline | Raphaël, Maurice | Teicher, Elina | Verny, Christiane | Vittecoq, Daniel | Wyplosz, Benjamin | Ben Hayoun, Michèle | Brun-Vezinet, Françoise | Casalino, Enrique | Choquet, Christophe | Duval, Xavier | Houhou, Nadhira | Joly, Véronique | Lescure, Xavier | Pogliaghi, Manuela | Rioux, Christophe | Yazdanpanah, Yazdan | Barros, Elsa | Begga, Belinda | Boukobza, Sébastien | Bouredji, Houria | Chouahi, Imad | Delacroix, Isabelle | Froissart, Antoine | Garrait, Valérie | Ngwem, Elsa | Phlippoteau, Catherine | Salehabadi, Sepehr | Toper, Cécile | Vinas, Florent | Amsilli, Marie | Epaulard, Olivier | Pavese, Patricia | Pierre, Isabelle | Stahl, Jean Paul | Aulagnier, Jérôme | Celerier, Julie | Cojocariu, Roxana | Rachline, Charlotte | Schoindre, Yoland | Sene, Thomas | Thierry, Christelle | Aparicio, Caroline | Lopes, Amanda | Pierre, Marjolaine Morgand | Sellier, Null | Simoneau, Guy | Chakvetadze, Catherine | Gauthier, Arnaud | Jidar, Kaoutar | Jourdain, Béatrice | Boitiaux, Jean Francois | Deschamps, Patrick | Devaud, Edouard | Philippe, Bruno | Chroboczek, Tomasz | Davido, Benjamin | de Truchis, Pierre | Chapuzet, Claire | Chauffrey, Laure | Etienne, Manuel | Joly, Luc Marie | Obstoy, Bérengère | Salaun, Mathieu | Thiberville, Luc | Tillon, Julie | Bollens, Diane | Bottero, Julie | Campa, Pauline | Cosqueric, Gäelle | Lefebvre, Bénédicte | Ouazene, Zineb | Pacanowski, Jérôme | Pateron, Dominique | Valin, Nadia | Compain, Caroline | Cordel, Hugues | Doumenc, Benoit | Fois, Elena | Gambier, Nicolas | Khuong, Marie Aude | Pasqualoni, Elisa | Poupard, Marie
Edité par
CCSD ; Elsevier for the European Society of Clinical Microbiology and Infectious Diseases -
International audience.
Objectives: In this study, we aimed to assess the efficacy of different ways of administration and types of beta-lactams for hospitalized community-acquired pneumonia (CAP). Methods: In this post-hoc analysis of randomized controlled trials (RCT) on patients hospitalized for CAP (pneumonia short treatment trial) comparing 3-day vs. 8-day durations of beta-lactams, which concluded to non-inferiority, we included patients who received either amoxicillin-clavulanate (AMC) or third-generation cephalosporin (3GC) regimens, and exclusively either intravenous or oral treatment for the first 3 days (followed by either 5 days of oral placebo or AMC according to randomization). The choice of route and molecule was left to the physician in charge. The main outcome was a failure at 15 days after the first antibiotic intake, defined as temperature >37.9°C, and/or absence of resolution/improvement of respiratory symptoms, and/or additional antibiotic treatment for any cause. The primary outcome according to the route of administration was evaluated through logistic regression. Inverse probability treatment weighting with a propensity score model was used to adjust for non-randomization of treatment routes and potential confounders. The difference in failure rates was also evaluated among several sub-populations (AMC vs. 3GC treatments, intravenous vs. oral AMC, patients with multi-lobar infection, patients aged ≥65 years old, and patients with CURB65 scores of 3u20134). Results: We included 200 patients from the original trial, with 93/200 (46.5%) patients only treated with intravenous treatment and 107/200 (53.5%) patients only treated with oral therapy. The failure rate at Day 15 was not significantly different among patients treated with initial intravenous vs. oral treatment [25/93 (26.9%) vs. 28/107 (26.2%), adjusted odds ratios (aOR) 0.973 (95% CI 0.519u20131.823), p 0.932)]. Failure rates at Day 15 were not significantly different among the subgroup populations. Discussion: Among hospitalized patients with CAP, there was no significant difference in efficacy between initial intravenous and exclusive oral treatment. Trial registration: This trial is registered with ClinicalTrials.gov, NCT01963442.
