Medical resource utilization among community-acquired pneumonia patients initially treated with levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily: A US-based study

Christopher R. Frei, T. C. Jaso, E. M. Mortensen, M. I. Restrepo, M. K. Raut, C. U. Oramasionwu, A. D. Ruiz, B. R. Makos, J. L. Ruiz, R. T. Attridge, S. H. Mody, A. Fisher, J. R. Schein

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: The 2007 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines recommend that community-acquired pneumonia (CAP) patients admitted to hospital wards initially receive respiratory fluoroquinolone monotherapy or β-lactam plus macrolide combination therapy. There is little evidence as to which regimen is preferred, or if differences in medical resource utilization exist between therapies. Thus, the authors compared length of hospital stay (LOS) and length of intravenous antibiotic therapy (LOIV) for patients who received initial levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily ('combination therapy'). Research design and methods: Adult hospital CAP cases from January 2005 to December 2007 were identified by principal discharge diagnosis code. Patients with a chest infiltrate and medical notes indicative of CAP were included. Direct intensive care unit admits and healthcare-associated cases were excluded. A propensity score technique was used to balance characteristics associated with initial antimicrobial therapy using multivariable regression to derive the scores. Propensity score categories, defined as propensity score quintiles, rather than propensity scores themselves, were used in the least squares regression model to assess the impact of LOS and LOIV. Results: A total of 495 patients from six hospitals met study criteria. Of these, 313 (63%) received levofloxacin and 182 (37%) received combination therapy. Groups were similar with respect to age, sex, most comorbidities, presenting signs and symptoms, and Pneumonia Severity Index (PSI) risk class. Patients on combination therapy were more likely to have heart failure and receive pre-admission antibiotics. Adjusted least squares mean (±SE) LOS and LOIV were shorter with levofloxacin versus combination therapy: LOS, 4.6 ± 0.17 vs. 5.4 ± 0.22 days, p < 0.01; and LOIV, 3.6 ± 0.17 vs. 4.8 ± 0.21 days, p < 0.01. Results for PSI risk class III or IV patients were: LOS, 5.0 ± 0.30 vs. 5.9 ± 0.37 days, p = 0.07; and LOIV, 3.7 ± 0.33 vs. 5.2 ± 0.39 days, p < 0.01. Due to the retrospective study design, limited sample size, and scope (single health-network), the authors encourage replication of this study in other data sources. Conclusions: Given the LOS and LOIV reductions of 0.8 and 1.2 days, respectively, utilization of levofloxacin 750 mg daily for CAP patients admitted to the medical floor has the potential to result in substantial cost savings for US hospitals.

Original languageEnglish (US)
Pages (from-to)859-868
Number of pages10
JournalCurrent Medical Research and Opinion
Volume25
Issue number4
DOIs
StatePublished - Apr 2009

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Levofloxacin
Azithromycin
Ceftriaxone
Length of Stay
Pneumonia
Propensity Score
Therapeutics
Least-Squares Analysis
Anti-Bacterial Agents
Lactams
Cost Savings
Information Storage and Retrieval
Fluoroquinolones
Macrolides
Sample Size
Signs and Symptoms
Intensive Care Units
Comorbidity
Research Design
Thorax

Keywords

  • Beta-lactam
  • Clinical practice guidelines
  • Community-acquired pneumonia
  • Fluoroquinolone
  • Length of stay
  • Macrolide

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Medical resource utilization among community-acquired pneumonia patients initially treated with levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily : A US-based study. / Frei, Christopher R.; Jaso, T. C.; Mortensen, E. M.; Restrepo, M. I.; Raut, M. K.; Oramasionwu, C. U.; Ruiz, A. D.; Makos, B. R.; Ruiz, J. L.; Attridge, R. T.; Mody, S. H.; Fisher, A.; Schein, J. R.

In: Current Medical Research and Opinion, Vol. 25, No. 4, 04.2009, p. 859-868.

Research output: Contribution to journalArticle

Frei, Christopher R. ; Jaso, T. C. ; Mortensen, E. M. ; Restrepo, M. I. ; Raut, M. K. ; Oramasionwu, C. U. ; Ruiz, A. D. ; Makos, B. R. ; Ruiz, J. L. ; Attridge, R. T. ; Mody, S. H. ; Fisher, A. ; Schein, J. R. / Medical resource utilization among community-acquired pneumonia patients initially treated with levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily : A US-based study. In: Current Medical Research and Opinion. 2009 ; Vol. 25, No. 4. pp. 859-868.
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abstract = "Objective: The 2007 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines recommend that community-acquired pneumonia (CAP) patients admitted to hospital wards initially receive respiratory fluoroquinolone monotherapy or β-lactam plus macrolide combination therapy. There is little evidence as to which regimen is preferred, or if differences in medical resource utilization exist between therapies. Thus, the authors compared length of hospital stay (LOS) and length of intravenous antibiotic therapy (LOIV) for patients who received initial levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily ('combination therapy'). Research design and methods: Adult hospital CAP cases from January 2005 to December 2007 were identified by principal discharge diagnosis code. Patients with a chest infiltrate and medical notes indicative of CAP were included. Direct intensive care unit admits and healthcare-associated cases were excluded. A propensity score technique was used to balance characteristics associated with initial antimicrobial therapy using multivariable regression to derive the scores. Propensity score categories, defined as propensity score quintiles, rather than propensity scores themselves, were used in the least squares regression model to assess the impact of LOS and LOIV. Results: A total of 495 patients from six hospitals met study criteria. Of these, 313 (63{\%}) received levofloxacin and 182 (37{\%}) received combination therapy. Groups were similar with respect to age, sex, most comorbidities, presenting signs and symptoms, and Pneumonia Severity Index (PSI) risk class. Patients on combination therapy were more likely to have heart failure and receive pre-admission antibiotics. Adjusted least squares mean (±SE) LOS and LOIV were shorter with levofloxacin versus combination therapy: LOS, 4.6 ± 0.17 vs. 5.4 ± 0.22 days, p < 0.01; and LOIV, 3.6 ± 0.17 vs. 4.8 ± 0.21 days, p < 0.01. Results for PSI risk class III or IV patients were: LOS, 5.0 ± 0.30 vs. 5.9 ± 0.37 days, p = 0.07; and LOIV, 3.7 ± 0.33 vs. 5.2 ± 0.39 days, p < 0.01. Due to the retrospective study design, limited sample size, and scope (single health-network), the authors encourage replication of this study in other data sources. Conclusions: Given the LOS and LOIV reductions of 0.8 and 1.2 days, respectively, utilization of levofloxacin 750 mg daily for CAP patients admitted to the medical floor has the potential to result in substantial cost savings for US hospitals.",
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author = "Frei, {Christopher R.} and Jaso, {T. C.} and Mortensen, {E. M.} and Restrepo, {M. I.} and Raut, {M. K.} and Oramasionwu, {C. U.} and Ruiz, {A. D.} and Makos, {B. R.} and Ruiz, {J. L.} and Attridge, {R. T.} and Mody, {S. H.} and A. Fisher and Schein, {J. R.}",
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T1 - Medical resource utilization among community-acquired pneumonia patients initially treated with levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily

T2 - A US-based study

AU - Frei, Christopher R.

AU - Jaso, T. C.

AU - Mortensen, E. M.

AU - Restrepo, M. I.

AU - Raut, M. K.

AU - Oramasionwu, C. U.

AU - Ruiz, A. D.

AU - Makos, B. R.

AU - Ruiz, J. L.

AU - Attridge, R. T.

AU - Mody, S. H.

AU - Fisher, A.

AU - Schein, J. R.

PY - 2009/4

Y1 - 2009/4

N2 - Objective: The 2007 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines recommend that community-acquired pneumonia (CAP) patients admitted to hospital wards initially receive respiratory fluoroquinolone monotherapy or β-lactam plus macrolide combination therapy. There is little evidence as to which regimen is preferred, or if differences in medical resource utilization exist between therapies. Thus, the authors compared length of hospital stay (LOS) and length of intravenous antibiotic therapy (LOIV) for patients who received initial levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily ('combination therapy'). Research design and methods: Adult hospital CAP cases from January 2005 to December 2007 were identified by principal discharge diagnosis code. Patients with a chest infiltrate and medical notes indicative of CAP were included. Direct intensive care unit admits and healthcare-associated cases were excluded. A propensity score technique was used to balance characteristics associated with initial antimicrobial therapy using multivariable regression to derive the scores. Propensity score categories, defined as propensity score quintiles, rather than propensity scores themselves, were used in the least squares regression model to assess the impact of LOS and LOIV. Results: A total of 495 patients from six hospitals met study criteria. Of these, 313 (63%) received levofloxacin and 182 (37%) received combination therapy. Groups were similar with respect to age, sex, most comorbidities, presenting signs and symptoms, and Pneumonia Severity Index (PSI) risk class. Patients on combination therapy were more likely to have heart failure and receive pre-admission antibiotics. Adjusted least squares mean (±SE) LOS and LOIV were shorter with levofloxacin versus combination therapy: LOS, 4.6 ± 0.17 vs. 5.4 ± 0.22 days, p < 0.01; and LOIV, 3.6 ± 0.17 vs. 4.8 ± 0.21 days, p < 0.01. Results for PSI risk class III or IV patients were: LOS, 5.0 ± 0.30 vs. 5.9 ± 0.37 days, p = 0.07; and LOIV, 3.7 ± 0.33 vs. 5.2 ± 0.39 days, p < 0.01. Due to the retrospective study design, limited sample size, and scope (single health-network), the authors encourage replication of this study in other data sources. Conclusions: Given the LOS and LOIV reductions of 0.8 and 1.2 days, respectively, utilization of levofloxacin 750 mg daily for CAP patients admitted to the medical floor has the potential to result in substantial cost savings for US hospitals.

AB - Objective: The 2007 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines recommend that community-acquired pneumonia (CAP) patients admitted to hospital wards initially receive respiratory fluoroquinolone monotherapy or β-lactam plus macrolide combination therapy. There is little evidence as to which regimen is preferred, or if differences in medical resource utilization exist between therapies. Thus, the authors compared length of hospital stay (LOS) and length of intravenous antibiotic therapy (LOIV) for patients who received initial levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily ('combination therapy'). Research design and methods: Adult hospital CAP cases from January 2005 to December 2007 were identified by principal discharge diagnosis code. Patients with a chest infiltrate and medical notes indicative of CAP were included. Direct intensive care unit admits and healthcare-associated cases were excluded. A propensity score technique was used to balance characteristics associated with initial antimicrobial therapy using multivariable regression to derive the scores. Propensity score categories, defined as propensity score quintiles, rather than propensity scores themselves, were used in the least squares regression model to assess the impact of LOS and LOIV. Results: A total of 495 patients from six hospitals met study criteria. Of these, 313 (63%) received levofloxacin and 182 (37%) received combination therapy. Groups were similar with respect to age, sex, most comorbidities, presenting signs and symptoms, and Pneumonia Severity Index (PSI) risk class. Patients on combination therapy were more likely to have heart failure and receive pre-admission antibiotics. Adjusted least squares mean (±SE) LOS and LOIV were shorter with levofloxacin versus combination therapy: LOS, 4.6 ± 0.17 vs. 5.4 ± 0.22 days, p < 0.01; and LOIV, 3.6 ± 0.17 vs. 4.8 ± 0.21 days, p < 0.01. Results for PSI risk class III or IV patients were: LOS, 5.0 ± 0.30 vs. 5.9 ± 0.37 days, p = 0.07; and LOIV, 3.7 ± 0.33 vs. 5.2 ± 0.39 days, p < 0.01. Due to the retrospective study design, limited sample size, and scope (single health-network), the authors encourage replication of this study in other data sources. Conclusions: Given the LOS and LOIV reductions of 0.8 and 1.2 days, respectively, utilization of levofloxacin 750 mg daily for CAP patients admitted to the medical floor has the potential to result in substantial cost savings for US hospitals.

KW - Beta-lactam

KW - Clinical practice guidelines

KW - Community-acquired pneumonia

KW - Fluoroquinolone

KW - Length of stay

KW - Macrolide

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