title: Association Between Initial Route of Fluoroquinolone Administration and Outcomes in Patients Hospitalized for Community-acquired Pneumonia.
abstract: Fluoroquinolones have equivalent oral and intravenous bioavailability, but hospitalized patients with community-acquired pneumonia (CAP) generally are treated intravenously. Our objectives were to compare outcomes of hospitalized CAP patients initially receiving intravenous vs oral respiratory fluoroquinolones.
  
  
  
  This was a retrospective cohort study utilizing data from 340 hospitals involving CAP patients admitted to a non-intensive care unit (ICU) setting from 2007 to 2010, who received intravenous or oral levofloxacin or moxifloxacin. The primary outcome was in-hospital mortality. Secondary outcomes included clinical deterioration (transfer to ICU, initiation of vasopressors, or invasive mechanical ventilation [IMV] initiated after the second hospital day), antibiotic escalation, length of stay (LOS), and cost.
  
  
  
  Of 36 405 patients who met inclusion criteria, 34 200 (94%) initially received intravenous treatment and 2205 (6%) received oral treatment. Patients who received oral fluoroquinolones had lower unadjusted mortality (1.4% vs 2.5%; P = .002), and shorter mean LOS (5.0 vs 5.3; P < .001). Multivariable models using stabilized inverse propensity treatment weighting revealed lower rates of antibiotic escalation for oral vs intravenous therapy (odds ratio [OR], 0.84; 95% confidence interval [CI], .74-.96) but no differences in hospital mortality (OR, 0.82; 95% CI, .58-1.15), LOS (difference in days 0.03; 95% CI, -.09-.15), cost (difference in $-7.7; 95% CI, -197.4-182.0), late ICU admission (OR, 1.04; 95% CI, .80-1.36), late IMV (OR, 1.17; 95% CI, .87-1.56), or late vasopressor use (OR, 0.94; 95% CI, .68-1.30).
  
  
  
  Among hospitalized patients who received fluoroquinolones for CAP, there was no association between initial route of administration and outcomes. More patients may be treated orally without worsening outcomes.
authors.affiliation: Division of General Medicine and Community Health, Baystate Medical Center, Springfield.|Tufts University School of Medicine, Boston.
authors.forename: Raquel K
authors.initials: RK
authors.lastname: Belforti
authors.affiliation: Division of General Medicine and Community Health, Baystate Medical Center, Springfield.|Tufts University School of Medicine, Boston.|Center for Quality of Care Research.
authors.forename: Tara
authors.initials: T
authors.lastname: Lagu
authors.affiliation: Division of General Medicine and Community Health, Baystate Medical Center, Springfield.|Tufts University School of Medicine, Boston.|Division of Infectious Diseases, Baystate Medical Center, Springfield.
authors.forename: Sarah
authors.initials: S
authors.lastname: Haessler
authors.affiliation: Division of General Medicine and Community Health, Baystate Medical Center, Springfield.|Tufts University School of Medicine, Boston.|Center for Quality of Care Research.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
authors.affiliation: Center for Quality of Care Research.|School of Public Health and Health Sciences, University of Massachusetts, Amherst.
authors.forename: Penelope S
authors.initials: PS
authors.lastname: Pekow
authors.affiliation: Center for Quality of Care Research.
authors.forename: Aruna
authors.initials: A
authors.lastname: Priya
authors.affiliation: EviMed Research Group, LLC, Goshen.
authors.forename: Marya D
authors.initials: MD
authors.lastname: Zilberberg
authors.affiliation: Division of General Medicine and Community Health, Baystate Medical Center, Springfield.|Tufts University School of Medicine, Boston.|Division of Infectious Diseases, Baystate Medical Center, Springfield.
authors.forename: Daniel
authors.initials: D
authors.lastname: Skiest
authors.affiliation: Division of General Medicine and Community Health, Baystate Medical Center, Springfield.|Tufts University School of Medicine, Boston.|Division of Pulmonary and Critical Care, Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Higgins
authors.affiliation: Division of General Medicine and Community Health, Baystate Medical Center, Springfield.|Tufts University School of Medicine, Boston.|Center for Quality of Care Research.
authors.forename: Mihaela S
authors.initials: MS
authors.lastname: Stefan
authors.affiliation: Department of Medicine, Medicine Institute, Cleveland Clinic, Ohio.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage* / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
keywords: community-acquired pneumonia; fluoroquinolones; oral antibiotics