title: Comparative Treatment Failure Rates of Respiratory Fluoroquinolones or β-Lactam + Macrolide Versus β-Lactam Alone in the Treatment for Community-Acquired Pneumonia in Adult Outpatients: An Analysis of a Nationally Representative Claims Database.
abstract: No comparative effectiveness study has been conducted for the following 3 antibiotics: respiratory fluoroquinolones, β-lactam, and β-lactam + advanced macrolide. To gain insights into the real-world clinical effectiveness of these antibiotics for community-acquired pneumonia in adult outpatients, our study investigated the treatment failure rates in 2 million representative participants from the National Health Informatics Project (NHIP) of Taiwan. A new-user cohort design was used to follow NHIP participants from January 2000 until December 2009. Treatment failure was defined by either one of the following events: a second antibiotic prescription, hospitalization due to CAP, an emergency department visit with a diagnosis of CAP, or 30-day nonaccident-related mortality. From 2006 to 2009, we identified 9256 newly diagnosed CAP outpatients, 1602 of whom were prescribed levofloxacin, 2100 were prescribed moxifloxacin, 5049 were prescribed β-lactam alone, and 505 were prescribed advanced macrolide + β-lactam. Compared with the β-lactam-based regimen, the propensity score-matched odds ratio for composite treatment failure was 0.81 (95% CI, 0.67-0.97) for moxifloxacin, 1.10 (95% CI, 0.90-1.35) for levofloxacin, and 0.95 (95% CI, 0.67-1.35) for macrolide +β-lactam. Moxifloxacin was associated with lower treatment failure rates compared with β-lactam alone, or levofloxacin in Taiwanese CAP outpatients. However, due to inherent limitations in our claims database, more randomized controlled trials are required before coming to a conclusion on which antibiotic is more effective for Taiwanese CAP outpatients. More population-based comparative effectiveness studies are also encouraged and should be considered as an integral piece of evidence in local CAP treatment guidelines.
authors.affiliation: From the Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan (M-TGL, S-HL, C-CL); Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (S-SC); Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan (S-SC); Department of International Business, Asia University, 500, Lioufeng Rd., Wufeng, Taichung City, Taiwan (Y-LC); Loyola University New Orleans College of Law 6363 St Charles Ave, New Orleans, LA (LP); Department of Business Administration, Tunghai University, Tunghai University, Taichung City, Taiwan (S-MH); and Department of Emergency Medicine and Department of General Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan (C-CL).
authors.forename: Meng-Tse Gabriel
authors.initials: MG
authors.lastname: Lee
authors.forename: Shih-Hao
authors.initials: SH
authors.lastname: Lee
authors.forename: Shy-Shin
authors.initials: SS
authors.lastname: Chang
authors.forename: Ya-Lan
authors.initials: YL
authors.lastname: Chan
authors.forename: Laura
authors.initials: L
authors.lastname: Pang
authors.forename: Sue-Ming
authors.initials: SM
authors.lastname: Hsu
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections; D016208:Databases, Factual; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D007345:Insurance Claim Review; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D013624:Taiwan; D017211:Treatment Failure; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D018942:Macrolides; D047090:beta-Lactams