title: Guideline adherence and macrolides reduced mortality in outpatients with pneumonia.
abstract: BACKGROUND
  For outpatients with pneumonia, guidelines recommend empiric antibiotics and some suggest macrolides are preferred agents. We hypothesized that both guideline-concordant antibiotics and macrolides would be associated with reduced mortality.
  
  
  METHODS
  All outpatients with pneumonia assessed at 7 Emergency Departments in Edmonton, Alberta, Canada were enrolled in a population-based registry that included clinical-radiographic data, Pneumonia Severity Index (PSI) and treatments. Guideline-concordant regimens included macrolides and respiratory fluoroquinolones; other regimens were "discordant". Main outcome was 30-day all-cause mortality.
  
  
  RESULTS
  The study included 2973 outpatients; mean age 51 years, 47% female, most had mild pneumonia (73% PSI Class I-II). Over 30-days, 38 (1%) patients died, 228 (8%) were hospitalized, and 253 (9%) reached the endpoint of death or hospitalization. Most (2845 [96%]) patients received guideline-concordant antibiotics. Compared to patients receiving discordant antibiotics, those receiving guideline-concordant antibiotics were less likely to die within 30-days (8 [6%] versus 30 [1%], adjusted OR 0.23, 95% CI 0.09-0.59, p = 0.002). Within the guideline-concordant subgroup, compared to the 947 (33%) patients treated with fluoroquinolones, those receiving macrolides [1847 (64%)] were less likely to die (25 [3%] versus 4 [0.2%], adjusted OR 0.28, 95% CI 0.09-0.86, p = 0.03).
  
  
  CONCLUSIONS
  In outpatients with pneumonia, treatment with guideline-concordant antibiotics and macrolides were both associated with mortality reduction.
authors.affiliation: Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Leyla
authors.initials: L
authors.lastname: Asadi
authors.forename: Dean T
authors.initials: DT
authors.lastname: Eurich
authors.forename: John-Michael
authors.initials: JM
authors.lastname: Gamble
authors.forename: Jasjeet K
authors.initials: JK
authors.lastname: Minhas-Sandhu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Marrie
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy; D019091:Critical Pathways / Q000592:standards; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000592:standards; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D018942:Macrolides