Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Department of Engineering Science, University of Oxford, Oxford, UK.
J Infect. 2024 Jun;88(6):106161. doi: 10.1016/j.jinf.2024.106161. Epub 2024 Apr 23.
Current guidelines recommend broad-spectrum antibiotics for high-severity community-acquired pneumonia (CAP), potentially contributing to antimicrobial resistance (AMR). We aim to compare outcomes in CAP patients treated with amoxicillin (narrow-spectrum) versus co-amoxiclav (broad-spectrum), to understand if narrow-spectrum antibiotics could be used more widely.
We analysed electronic health records from adults (≥16 y) admitted to hospital with a primary diagnosis of pneumonia between 01-January-2016 and 30-September-2023 in Oxfordshire, United Kingdom. Patients receiving baseline ([-12 h,+24 h] from admission) amoxicillin or co-amoxiclav were included. The association between 30-day all-cause mortality and baseline antibiotic was examined using propensity score (PS) matching and inverse probability treatment weighting (IPTW) to address confounding by baseline characteristics and disease severity. Subgroup analyses by disease severity and sensitivity analyses with missing covariates imputed were also conducted.
Among 16,072 admissions with a primary diagnosis of pneumonia, 9685 received either baseline amoxicillin or co-amoxiclav. There was no evidence of a difference in 30-day mortality between patients receiving initial co-amoxiclav vs. amoxicillin (PS matching: marginal odds ratio 0.97 [0.76-1.27], p = 0.61; IPTW: 1.02 [0.78-1.33], p = 0.87). Results remained similar across stratified analyses of mild, moderate, and severe pneumonia. Results were also similar with missing data imputed. There was also no evidence of an association between 30-day mortality and use of additional macrolides or additional doxycycline.
There was no evidence of co-amoxiclav being advantageous over amoxicillin for treatment of CAP in 30-day mortality at a population-level, regardless of disease severity. Wider use of narrow-spectrum empirical treatment of moderate/severe CAP should be considered to curb potential for AMR.
目前的指南建议对高严重性社区获得性肺炎（CAP）使用广谱抗生素，这可能导致抗生素耐药性（AMR）。我们旨在比较 CAP 患者使用阿莫西林（窄谱）与复方阿莫西林（广谱）治疗的结果，以了解是否可以更广泛地使用窄谱抗生素。
我们分析了 2016 年 1 月 1 日至 2023 年 9 月 30 日期间在英国牛津郡因肺炎住院的成年人（≥16 岁）的电子健康记录。纳入了在入院前（[-12 小时，+24 小时]）接受基线阿莫西林或复方阿莫西林治疗的患者。使用倾向评分（PS）匹配和逆概率治疗加权（IPTW）来校正基线特征和疾病严重程度的混杂因素，比较了 30 天全因死亡率与基线抗生素之间的关系。还进行了按疾病严重程度的亚组分析和缺失协变量推断的敏感性分析。
在 16072 例因肺炎入院的患者中，9685 例患者接受了基线阿莫西林或复方阿莫西林治疗。接受初始复方阿莫西林治疗的患者与接受阿莫西林治疗的患者在 30 天死亡率方面没有差异（PS 匹配：边缘优势比 0.97 [0.76-1.27]，p=0.61；IPTW：1.02 [0.78-1.33]，p=0.87）。在轻度、中度和重度肺炎的分层分析中，结果仍然相似。在缺失数据推断后，结果也相似。在 30 天死亡率与使用额外大环内酯类药物或额外多西环素之间也没有证据表明存在关联。
在人群水平上，无论疾病严重程度如何，在 30 天死亡率方面，没有证据表明复方阿莫西林治疗 CAP 优于阿莫西林。应考虑更广泛地使用窄谱经验性治疗中重度 CAP，以遏制潜在的 AMR。
