title: Fluoroquinolones versus β-Lactam/β-Lactamase Inhibitors in Outpatients with Chronic Obstructive Pulmonary Disease and Pneumonia: A Nationwide Population-Based Study.
abstract: BACKGROUND
  Studies on the association between antibiotic treatment and outcomes in outpatients with chronic obstructive pulmonary disease (COPD) and pneumonia are scarce. This study aimed to evaluate the effectiveness of fluoroquinolones and β-lactam/β-lactamase inhibitors for pneumonia in COPD outpatients.
  
  
  METHODS
  We conducted a retrospective cohort study and identified 4,851 episodes of pneumonia among COPD outpatients treated with fluoroquinolones or β-lactam/β-lactamase inhibitors from the Taiwan National Health Insurance Research Database during 2002-2011. Using the propensity score analysis, 1,296 pairs of episodes were matched for the demographic and clinical characteristics. The primary outcome was pneumonia/empyema-related hospitalization or emergency department (ED) visits, and the secondary outcomes were treatment failure, all-cause mortality and medical costs within 30 days.
  
  
  RESULTS
  Compared with episodes treated with β-lactam/β-lactamase inhibitors, episodes treated with fluoroquinolones had similar clinical outcomes. The rates of pneumonia/empyema-related hospitalization or ED visits were 3.9% and 3.5% in the fluoroquinolone and β-lactam/β-lactamase inhibitor groups, respectively (adjusted hazard ratio [aHR], 1.11; 95% confidence interval [CI], 0.74-1.66). The percentage of treatment failure and all-cause mortality were 28.2% versus 31.3% (adjusted odds ratio, 0.86; 95% CI, 0.73-1.02) and 0.5% versus 0.4% (aHR, 1.40; 95% CI, 0.45-4.41) in the fluoroquinolone and β-lactam/β-lactamase inhibitor groups, respectively. The medical expenditures, including total medical costs (528 versus 455 US dollars) and pneumonia-related costs (202 vs. 155 USD) were also balanced between the two treatment groups (both P >0.05).
  
  
  CONCLUSIONS
  For pneumonia in COPD outpatients, fluoroquinolones were associated with similar clinical outcomes and medical expenditures compared with β-lactam/β-lactamase inhibitors.
authors: Center for Drug Evaluation, Taipei, Taiwan.
authors: Kuan-Yin
authors: KY
authors: Lin
authors: School of Pharmacy, National Taiwan University, Taipei, Taiwan.
authors: Chi-Chuan
authors: CC
authors: Wang
authors: Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
authors: Chia-Hui
authors: CH
authors: Lin
authors: Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Wang-Huei
authors: WH
authors: Sheng
authors: Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Shan-Chwen
authors: SC
authors: Chang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology*; D011159:Population Surveillance; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D065093:beta-Lactamase Inhibitors / Q000627:therapeutic use*
chemical_list: D024841:Fluoroquinolones; D065093:beta-Lactamase Inhibitors