Analysis of antibiotic prescriptions in patients with community-acquired pneumonia in clinical practice

Clinical Microbiology and Antimicrobial Chemotherapy. 2022; 24(4):388-394

​ Taube A.A., Alexandrova T.V., Demidova O.A., Zhuravleva M.V., Stepanov E.A., Alyautdin R.N.
10.36488/cmac.2022.4.388-394
community-acquired pneumonia real world data antibiotics efficacy clinical guidelines
Section
Personal Experience
Type
Original Article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2022; 24(4):388-394

Objective.

To analyze new strategies for the treatment of community-acquired pneumonia (CAP) by age and assess treatment efficacy by age category based on real world data.

Materials and Methods.

A total of 612 patients (medical charts) with CAP treated in 3 hospitals during the 2017–2019 were included in the retrospective pharmacoepidemiological study. A retrospective analysis of antimicrobial therapy (AMT) administration in the treatment of CAP was performed.

Results.

Duration of hospital stay in CAP patients of young age was 10% shorter than in patients of any other age category. The least frequency (19.6%) of antibiotic combination administration as initial empiric therapy was found in patients of young age. There were no significant differences in frequency of initial AMT administration between age groups. Ceftriaxone, cefepime and cefoperazone were the most common antimicrobials used as monotherapy in all age groups. Ceftriaxone with azithromycin combination was the most common (42%) initial combination therapy in all age groups. The highest number (27) of various antibiotic combinations was administered to old patients, and the lowest number (16) – to young patients. Efficacy of initial AMT was similar between elderly and old patients. Overall efficacy of initial AMT in patients with non-severe CAP and severe CAP was 54% and 50%, respectively. Analysis of antimicrobial treatment of CAP in real practice and its compliance with the current clinical guidelines showed cephalosporin plus macrolide to be a predominant antibiotic combination (83%).

Conclusions.

Antibiotic combination administration was found to be common in patients with non-severe CAP, whereas initial monotherapy was administered to severe CAP patients. Antibiotic prescription pattern in patient of young age was different from that in any other age groups. CAP had a less severe course in young patients as evidenced by shorter duration of hospital stay, more frequent monotherapy administration and higher efficacy of initial AMT compared to other age categories. There were no prescriptions of the recommended fifth generation cephalosporin (ceftaroline fosamil).

Aleksandra A. Taube

Scientific Centre for Expert Evaluation of Medicinal Products, Moscow, Russia

Alexandrova T.V.

Scientific Centre for Expert Evaluation of Medicinal Products, Moscow, Russia

Demidova O.A.

Scientific Centre for Expert Evaluation of Medicinal Products, Moscow, Russia

Zhuravleva M.V.

Scientific Centre for Expert Evaluation of Medicinal Products, Moscow, Russia

Stepanov E.A.

Charles University, Prague, Czech Republic

Alyautdin R.N.

Scientific Centre for Expert Evaluation of Medicinal Products, Moscow, Russia

  • 1. Peyrani P., Mandell L., Torres A., Tillotson G.S. The burden of community-acquired bacterial pneumonia in the era of antibiotic resistance. Expert Rev Respir Med. 2019;13(2): 139-152. DOI: 10.1080/17476348.2019.1562339
  • 2. Heo J.Y., Song J.Y. Disease burden and etiologic distribution of community-acquired pneumonia in adults: evolving epidemiology in the era of pneumococcal conjugate vaccines. Infect Chemother. 2018;50(4):287-300. DOI: 10.3947/ic.2018.50.4.287
  • 3. Russian Respiratory Society. Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. Clinical guidelines «Community-acquired pneumonia in adults», 2019. Russian
  • 4. Baek J.Y., Kang C.I., Kim S.H., Ko K.S., Chung D.R., Peck K.R., Lee N.Y., Song J.H. Emergence of multidrugresistant clones in levofloxacin-nonsusceptible Streptococcus pneumoniae isolates in Korea. Diagn Microbiol Infect Dis. 2018;91(3):287-290. DOI: 10.1016/j.diagmicrobio.2018.02.010
  • 5. Park M., Kim H.S., Kim H.S., Park J.Y., Song W., Cho H.C., Kim J.S. Novel levofloxacin-resistant multidrug-resistant Streptococcus pneumoniae serotype 11A isolates, South Korea. Emerg Infect Dis. 2016;22:1978-1980. DOI: 10.3201/eid2211.151450
  • 6. Yakovlev S.V., Suvorova M.P., Bykov A.O. Cefepime/sulbactam – a new innovative antibiotic for in-hospital treatment of severe infections and the implementation of carbapenem-replacement strategy to contain antibiotic resistance. Antibiotiki i himioterapija. 2021;66(3-4):8298. Russian. DOI: 10.37489/0235-2990-2021-66-3-4-82-98
  • 7. Avdeev S.N., Dekhnich A.V., Zaytsev A.A., Kozlov R.S., Rachina S.A., Rudnov V.A., et al. Federal guidelines on diagnosis and treatment of community-acquired pneumonia. Pulmonology. 2022;32(3):295-355. Russian. DOI: 10.18093/0869-0189-2022-32-3-295-355
  • 8. Malyarchikov A.V., Shаpovаlov K.G. 4-1BB/4-1BBL signaling pathway in patients with influenza A (H1N1) virus-associated pneumonia. Fundamental and clinical medicine. 2022;7(1):64-69. Russian. DOI: 10.23946/2500-0764-20227-1-64-69
  • 9. Danilov A.I., Kozlov S.N., Evseev A.V., Starkova A.E., Efimova I.A., Emelyanova E.S., et al. Features of antimicrobial therapy of infective endocarditis in Smolensk. Bulletin of the Smolensk State Medical Academy. 2019;18(2):8589. Russian.
  • 10. Zaitsev A.A., Sinopalnikov A.I., Kryukov E.V. Communityacquired pneumonia: current clinical recommendations. Russian military medical journal. 2020;341(4):26-37. Russian. DOI: 10.17816/RMMJ82227
  • 11. Zaitsev A.A., Sinopalnikov A.I. Practical guidelines for the patient management with non-severe community-acquired pneumonia. Russian medical journal. 2020;4:19-23. Russian.
  • 12. Avdeev S.N., Beloborodov V.B., Belotserkovskiy B.Z., Gritsan A.I., Dekhnich A.V., Zaytsev A.A., et al. Severe community-acquired pneumonia in adults. Clinical recommendations from Russian Federation of Anaesthesiologists and Reanimatologists. Russian journal of anaesthesiology and reanimatology. 2022;(1):6-35. Russian. DOI: 10.17116/anaesthesiology20220116
  • 13. Guchev I.A., Melehina E.V. Inhibitor-protected aminopenicillins. pharmacological characterization and role in community-acquired infections. Antibiotiki i himioterapija. 2009;54(7-8):56-65. Russian.
  • 14. Choi M.J., Noh J.Y., Cheong H.J., Kim W.J., Kim M.J., Jang Y.S., Song J.Y. Spread of ceftriaxone non-susceptible pneumococci in South Korea: long-term care facilities as a potential reservoir. PLoS One. 2018;14(1):e0210520. DOI: 10.1371/journal.pone.0210520
Views
0 Abstract
0 PDF
0 Crossref citations
Shared