title: Comparative antibiotic failure rates in the treatment of community-acquired pneumonia: Results from a claims analysis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: SDI, Plymouth Meeting, PA 19462, USA. greg.hess@wharton.upenn.edu
authors.forename: Gregory
authors.initials: G
authors.lastname: Hess
authors.forename: Jerrold W
authors.initials: JW
authors.lastname: Hill
authors.forename: Monika K
authors.initials: MK
authors.lastname: Raut
authors.forename: Alan C
authors.initials: AC
authors.lastname: Fisher
authors.forename: Samir
authors.initials: S
authors.lastname: Mody
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Schein
authors.forename: Chi-Chang
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin
references.citation: J Manag Care Pharm. 2009 Mar;15(2 Suppl):S5-11
references.pmid: 19236135
references.citation: Am J Manag Care. 2008 Apr;14(4):190-6
references.pmid: 18402511
references.citation: Clin Ther. 2008 Feb;30(2):358-71
references.pmid: 18343274
references.citation: Emerg Infect Dis. 2005 Jun;11(6):802-7
references.pmid: 15963272
references.citation: Curr Opin Pulm Med. 2009 May;15(3):261-73
references.pmid: 19387263
references.citation: Am J Respir Crit Care Med. 2000 Jul;162(1):154-60
references.pmid: 10903235
references.citation: Semin Respir Crit Care Med. 2009 Apr;30(2):179-88
references.pmid: 19296418
references.citation: Chest. 2007 Oct;132(4):1348-55
references.pmid: 17934120
references.citation: Med Care. 2007 Jun;45(6):579-83
references.pmid: 17515786
references.citation: Chest. 1990 Mar;97(3):576-82
references.pmid: 2306961
references.citation: Ann Intern Med. 2009 Oct 6;151(7):ITC4-2-ITC4-14; quiz ITC4-16
references.pmid: 19805767
references.citation: Semin Respir Crit Care Med. 2009 Apr;30(2):154-60
references.pmid: 19296415
references.citation: Natl Health Stat Report. 2008 Aug 6;(8):1-29
references.pmid: 18958997
references.citation: Drugs. 2003;63(2):181-205
references.pmid: 12515565
references.citation: Thorax. 2004 Nov;59(11):960-5
references.pmid: 15516472
references.citation: Arch Intern Med. 2004 Mar 8;164(5):502-8
references.pmid: 15006826
references.citation: J Infect Chemother. 2009 Dec;15(6):347-60
references.pmid: 20012724
references.citation: J Chemother. 2007 Oct;19(5):536-45
references.pmid: 18073153
references.citation: Natl Health Stat Report. 2008 Jul 30;(5):1-20
references.pmid: 18841653
references.citation: Cochrane Database Syst Rev. 2004;(2):CD002109
references.pmid: 15106168
references.citation: Chemotherapy. 2004;50 Suppl 1:3-10
references.pmid: 15319548
references.citation: Natl Vital Stat Rep. 2009 Apr 17;57(14):1-134
references.pmid: 19788058
references.citation: Emerg Infect Dis. 2009 Aug;15(8):1260-4
references.pmid: 19751588