Association Between Initial Route of Fluoroquinolone Administration and Outcomes in Patients Hospitalized for Community Acquired Pneumonia.
Clin Infect Dis. 2016 Apr 5;
Authors: Belforti RK, Lagu T, Haessler S, Lindenauer PK, Pekow PS, Priya A, Zilberberg MD, Skiest D, Higgins TL, Stefan MS, Rothberg MB
BACKGROUND: 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 versus oral respiratory fluoroquinolones.
METHODS: Retrospective cohort study utilizing data from 340 hospitals involving CAP patients admitted to a non-intensive care setting from 2007-2010, who received intravenous (IV) or oral (PO) levofloxacin or moxifloxacin. The primary outcome was in-hospital mortality. Secondary outcomes included clinical deterioration (transfer to intensive care or invasive mechanical ventilation (IMV) initiated after the second hospital day, antibiotic escalation, length of stay, and cost.
RESULTS: Of 36,405 patients who met inclusion criteria, 34,200 (94%) initially received IV treatment and 2205 (6%) received PO treatment. Patients who received PO fluoroquinolones had lower unadjusted mortality (1.4% versus 2.5%, p=0.001), and shorter mean length of stay (5.0 versus 5.3, p<0.001). Multivariable models using Stabilized Inverse Propensity Treatment Weights (SIPTW) revealed lower rates of antibiotic escalation for PO vs. IV (OR 0.84, 95% CI 0.74-0.96) but no differences in hospital mortality (OR 0.82; 95% CI 0.58-1.15), length of stay (RR 1.01; 95% CI 0.98-1.03), cost (RR 1.00; 95% CI 0.98-1.02), late ICU admission (OR 1.04; 95% CI 0.80-1.36), late IMV (OR 1.17; 95% CI 0.87-1.56), or late vasopressors (OR 0.94; 95% CI 0.68-1.30).
CONCLUSION: 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.
PMID: 27048748 [PubMed - as supplied by publisher]