Limits...
Fluoroquinolones versus β-Lactam/β-Lactamase Inhibitors in Outpatients with Chronic Obstructive Pulmonary Disease and Pneumonia: A Nationwide Population-Based Study.

Lin KY, Wang CC, Lin CH, Sheng WH, Chang SC - PLoS ONE (2015)

Bottom Line: Compared with episodes treated with β-lactam/β-lactamase inhibitors, episodes treated with fluoroquinolones had similar clinical outcomes.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).For pneumonia in COPD outpatients, fluoroquinolones were associated with similar clinical outcomes and medical expenditures compared with β-lactam/β-lactamase inhibitors.

View Article: PubMed Central - PubMed

Affiliation: Center for Drug Evaluation, Taipei, Taiwan.

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.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of patient selection.Abbreviations: COPD, chronic obstructive pulmonary disease; ED, emergency department; IVIG, intravenous immunoglobulin; NHIRD, National Health Insurance Research Database.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4549331&req=5

pone.0136232.g001: Flow diagram of patient selection.Abbreviations: COPD, chronic obstructive pulmonary disease; ED, emergency department; IVIG, intravenous immunoglobulin; NHIRD, National Health Insurance Research Database.

Mentions: A total of 4,851 episodes of pneumonia among COPD patients were included in the analyses. Of them, 1,386 episodes were treated with fluoroquinolones and 3,465 episodes were treated with β-lactam/β-lactamase inhibitors plus macrolides or not, respectively. After propensity score matching, 1,296 matched pairs of episodes were matched with a one-to-one ratio (Fig 1). The demographics and clinical characteristics of episodes in the unadjusted cohorts treated with fluoroquinolones and β-lactam/β-lactamase inhibitors are listed in Table 1. Compared with episodes treated with β-lactam/β-lactamase inhibitors, episodes treated with fluoroquinolones were younger (66.0 years versus 67.3 years, P = 0.01), less likely to be male (54.9% versus 61.1%, P<0.01), and had a lower proportion of cerebrovascular diseases (17.2% vs. 21.2%, P<0.01). In both fluoroquinolone and β-lactam/β-lactamase inhibitor groups, there were over 70% and 30% of patients exposed to any antibiotics in the past 1 year and 3 months. Long-term oral corticosteroids were prescribed in about one-third of patients in the previous year. The rate of hospitalization or ED visits due to acute exacerbation of COPD or pneumonia in the past year was 5% of our study patients. In attempt to balance the imbalance of covariates between two treatment groups, the propensity score matching analysis was performed. The demographics and clinical characteristics of adjusted cohorts, also listed in Table 1, were all balanced.


Fluoroquinolones versus β-Lactam/β-Lactamase Inhibitors in Outpatients with Chronic Obstructive Pulmonary Disease and Pneumonia: A Nationwide Population-Based Study.

Lin KY, Wang CC, Lin CH, Sheng WH, Chang SC - PLoS ONE (2015)

Flow diagram of patient selection.Abbreviations: COPD, chronic obstructive pulmonary disease; ED, emergency department; IVIG, intravenous immunoglobulin; NHIRD, National Health Insurance Research Database.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4549331&req=5

pone.0136232.g001: Flow diagram of patient selection.Abbreviations: COPD, chronic obstructive pulmonary disease; ED, emergency department; IVIG, intravenous immunoglobulin; NHIRD, National Health Insurance Research Database.
Mentions: A total of 4,851 episodes of pneumonia among COPD patients were included in the analyses. Of them, 1,386 episodes were treated with fluoroquinolones and 3,465 episodes were treated with β-lactam/β-lactamase inhibitors plus macrolides or not, respectively. After propensity score matching, 1,296 matched pairs of episodes were matched with a one-to-one ratio (Fig 1). The demographics and clinical characteristics of episodes in the unadjusted cohorts treated with fluoroquinolones and β-lactam/β-lactamase inhibitors are listed in Table 1. Compared with episodes treated with β-lactam/β-lactamase inhibitors, episodes treated with fluoroquinolones were younger (66.0 years versus 67.3 years, P = 0.01), less likely to be male (54.9% versus 61.1%, P<0.01), and had a lower proportion of cerebrovascular diseases (17.2% vs. 21.2%, P<0.01). In both fluoroquinolone and β-lactam/β-lactamase inhibitor groups, there were over 70% and 30% of patients exposed to any antibiotics in the past 1 year and 3 months. Long-term oral corticosteroids were prescribed in about one-third of patients in the previous year. The rate of hospitalization or ED visits due to acute exacerbation of COPD or pneumonia in the past year was 5% of our study patients. In attempt to balance the imbalance of covariates between two treatment groups, the propensity score matching analysis was performed. The demographics and clinical characteristics of adjusted cohorts, also listed in Table 1, were all balanced.

Bottom Line: Compared with episodes treated with β-lactam/β-lactamase inhibitors, episodes treated with fluoroquinolones had similar clinical outcomes.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).For pneumonia in COPD outpatients, fluoroquinolones were associated with similar clinical outcomes and medical expenditures compared with β-lactam/β-lactamase inhibitors.

View Article: PubMed Central - PubMed

Affiliation: Center for Drug Evaluation, Taipei, Taiwan.

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.

No MeSH data available.


Related in: MedlinePlus