SDI, Plymouth Meeting, PA 19462, USA.
Adv Ther. 2010 Oct;27(10):743-55. doi: 10.1007/s12325-010-0062-1. Epub 2010 Aug 26.
Antibiotic treatment failure contributes to the economic and humanistic burdens of community-acquired pneumonia (CAP) by increasing morbidity, mortality, and healthcare costs. This study compared treatment failure rates of levofloxacin with those of other antibiotics in a large US sample.
Medical and pharmacy claims in the nationally representative SDI database were used to identify adults with a new outpatient diagnosis of CAP receiving a study antibiotic (levofloxacin, amoxicillin/clavulanate, azithromycin, moxifloxacin) between September 1, 2005 and March 31, 2008. Treatment failure was defined as ≥1 of the following events ≤30 days after index date: a refill for the index antibiotic after completed days of therapy, a different antibiotic dispensed >1 day after the index prescription, or hospitalization with a pneumonia diagnosis or emergency department visit >3 days postindex. Cohorts were propensity score matched for demographic and clinical characteristics. Treatment failure rates were compared between pairs of cohorts for the full sample and for high-risk patients (age ≥65 and/or on Medicaid).
Among the 3994 study patients, the numbers of dispensed index prescriptions were 268 for amoxicillin/clavulanate, 1609 for azithromycin, 1460 for levofloxacin, and 657 for moxifloxacin. Unadjusted treatment failure rates for the sample were 20.8% for levofloxacin, 23.9% for amoxicillin/clavulanate, 23.9% for azithromycin, and 19.9% for moxifloxacin. For high-risk patients, unadjusted treatment failure rates were 19.1% for levofloxacin, 26.1% for amoxicillin/clavulanate, 26.3% for azithromycin, and 24.3% for moxifloxacin. Propensity score-matched treatment failure rates were significantly lower with levofloxacin than azithromycin (19.8% vs. 24.5%, odds ratio [OR] comparator vs. levofloxacin 1.38; 95% CI: 1.14, 1.67), a difference amplified in high-risk patients (19.0% vs. 26.4%, OR 1.61; 95% CI: 1.22, 2.13). No significant differences were observed for other paired comparisons.
In a large US sample, treatment failure in CAP appeared to be less likely with quinolones (such as levofloxacin) than azithromycin, an effect particularly marked in high-risk patients (age ≥65 and/or on Medicaid).
抗生素治疗失败会增加发病率、死亡率和医疗保健成本，从而给社区获得性肺炎（CAP）带来经济和人文负担。本研究比较了左氧氟沙星与其他抗生素在大型美国样本中的治疗失败率。
使用全国代表性的 SDI 数据库中的医疗和药房数据，确定 2005 年 9 月 1 日至 2008 年 3 月 31 日期间新诊断为门诊 CAP 并接受研究抗生素（左氧氟沙星、阿莫西林/克拉维酸、阿奇霉素、莫西沙星）治疗的成年人。治疗失败定义为在索引日期后 30 天内发生以下 1 次或多次事件：索引抗生素的治疗天数完成后，再次开出处方；索引处方后 1 天以上，开具另一种抗生素；因肺炎诊断或急诊就诊而住院≥3 天。按照人口统计学和临床特征对队列进行倾向评分匹配。对全样本和高危患者（年龄≥65 岁和/或接受医疗补助）的配对队列进行治疗失败率比较。
在 3994 名研究患者中，开具的索引处方数分别为：阿莫西林/克拉维酸 268 例、阿奇霉素 1609 例、左氧氟沙星 1460 例、莫西沙星 657 例。全样本未调整的治疗失败率分别为左氧氟沙星 20.8%、阿莫西林/克拉维酸 23.9%、阿奇霉素 23.9%、莫西沙星 19.9%。高危患者中，未调整的治疗失败率分别为左氧氟沙星 19.1%、阿莫西林/克拉维酸 26.1%、阿奇霉素 26.3%、莫西沙星 24.3%。左氧氟沙星与阿奇霉素相比，经倾向评分匹配后的治疗失败率显著降低（24.5%，优势比[OR]比较药物与左氧氟沙星为 1.38；95%置信区间：1.14，1.67），在高危患者中，这种差异更为显著（26.4%，OR 1.61；95%置信区间：1.22，2.13）。其他配对比较未见显著差异。
在一项大型美国样本中，与阿奇霉素（如左氧氟沙星）相比，喹诺酮类药物（如左氧氟沙星）治疗 CAP 的失败率似乎较低，在高危患者（年龄≥65 岁和/或接受医疗补助）中效果更为显著。
