Wu Jasmanda H, Howard David H, McGowan John E, Frau Lourdes M, Dai Wanju S
Global Pharmacovigilance & Epidemiology, Aventis Pharmaceuticals, 200 Crossing Boulevard, Mailcode BWX 400-406E, Bridgewater, NJ 08807, USA.
Clin Ther. 2004 Dec;26(12):2153-62. doi: 10.1016/j.clinthera.2004.12.016.
Macrolide antibiotics are used as first-line therapy for the treatment of respiratory tract infections. The recent emergence of macrolide-resistant pathogens is a major concern.
This study quantifies the frequency of macrolide treatment failure in respiratory infections and examines its impact on health care use.
Patients with respiratory infections treated with macrolides in outpatient clinics from January to December 2002 were identified from a health insurance claims database. Macrolide treatment failure was defined as the receipt of a second antibiotic, different from the first, within 4 weeks after the initial macrolide. The end points were numbers of hospitalizations and emergency department and office visits within 1 month after the initial macrolide. We examined diagnostic codes on claim forms for posttreatment hospitalizations and visits to identify those most likely to be related to treatment failure as opposed to other causes. Utilization data were analyzed by Poisson regression to control for confounding variables.
The patients were divided into acute sinusitis (n = 111,135), acute bronchitis (n = 157,360), and community-acquired pneumonia (n = 36,212). Of these respective groups, 11,285 (10.2%), 15,498 (9.9%), and 4144 (11.4%) received a second antibiotic within 4 weeks. This subgroup with macrolide treatment failure was older, included more women, and had used more medical care before the index visit compared with patients with treatment success. After adjustment for age, sex, and previous health care use, patients experiencing treatment failure were more likely to be admitted to the hospital or to use emergency department or outpatient care after the index visit. This association was strongest for admissions and visits pertaining to the care of respiratory infections.
By our definition, about 10% of patients with respiratory infections who were treated with macrolide antibiotics experienced treatment failure within 4 weeks. Macrolide treatment failure was associated with increased health care utilization.
大环内酯类抗生素被用作治疗呼吸道感染的一线疗法。近期出现的大环内酯类耐药病原体是一个主要问题。
本研究对呼吸道感染中大环内酯类治疗失败的频率进行量化，并考察其对医疗保健利用情况的影响。
从一个医疗保险理赔数据库中识别出2002年1月至12月在门诊接受大环内酯类治疗的呼吸道感染患者。大环内酯类治疗失败被定义为在首次使用大环内酯类药物后的4周内接受了与第一种不同的第二种抗生素治疗。终点指标为首次使用大环内酯类药物后1个月内的住院次数、急诊就诊次数和门诊就诊次数。我们检查了理赔表格上关于治疗后住院和就诊的诊断代码，以确定那些最有可能与治疗失败相关而非其他原因的情况。利用泊松回归分析利用数据，以控制混杂变量。
患者被分为急性鼻窦炎（n = 111,135）、急性支气管炎（n = 157,360）和社区获得性肺炎（n = 36,212）。在这些各自的组中，分别有11,285（10.2%）、15,498（9.9%）和4144（11.4%）在4周内接受了第二种抗生素治疗。与治疗成功的患者相比，这个大环内酯类治疗失败的亚组年龄更大，女性更多，并且在本次就诊前使用了更多的医疗服务。在对年龄、性别和先前的医疗保健使用情况进行调整后，经历治疗失败的患者在本次就诊后更有可能住院或使用急诊或门诊服务。这种关联在与呼吸道感染护理相关的住院和就诊方面最为强烈。
按照我们的定义，接受大环内酯类抗生素治疗的呼吸道感染患者中约有10%在4周内经历了治疗失败。大环内酯类治疗失败与医疗保健利用率增加相关。
