Patients with pneumonia can initially be treated with most common antibiotics.

According to research carried out by University Medical Center Utrecht (UMCU) in the Netherlands, they are just as effective as the more expensive alternatives. The fact that bacteria are less likely to become resistant to these beta-lactam antibiotics is an additional benefit. The results of this study were published today in the New England Journal of Medicine. 

Various types of antibiotics are available to patients who are hospitalized with pneumonia. However, the preferred antibiotics for the initial treatment had not yet been properly investigated. That is why researchers at UMC Utrecht compared three different treatment strategies. In seven participating hospitals, one group of patients was started on a beta-lactam antibiotic, a traditional medicine similar to penicillin. A second group was given the same type, combined with a macrolide antibiotic. The third group was given a relatively new fluoroquinolone antibiotic. The last two strategies target a broad spectrum of bacteria.

No difference

The researchers assessed how many patients had died after 90 days. Mortality was approximately 10% in all groups: 59 out of 656 patients under the beta-lactam strategy died (9.0%). Of the 739 patients following the beta-lactam/macrolide strategy, 82 (11.1%) died. Under the fluoroquinolone strategy, the mortality was 78 out of 888 patients (8.8%). Under each strategy, patients spent an average of 6 days in hospital. The researchers therefore concluded that there is no difference in the effectiveness of these treatment strategies.

Resistance

Beta-lactam antibiotics have the benefit of being less likely to cause antibiotic resistance than the other types of antibiotics. The rising rates of bacteria that are resistant to antibiotics is considered a major problem. “Dutch doctors allready prescribe preferably beta-lactam for patients with non-hospital acquired pneumonia who are admitted to the nursing ward,” says Marc Bonten, professor of Molecular Epidemiology of Infectious Diseases at UMC Utrecht and principal investigator of the study. “Although we do see a shift towards the use of broader drugs. This is a harmful development.” In countries other than the Netherlands antibiotics are generally used with much less caution.

Special design

This research study is the first to directly compare the various antibiotics. To this end, all pneumonia patients in seven hospitals were treated according to a single specific strategy. The hospitals changed their strategy every four months. The study ran over a period of two years. Patients who were so ill that they were immediately transferred to the intensive care unit upon admission were excluded from the study. In cases where there were medical reasons to start on or switch to a specific antibiotic from another group, this was done. These patients were, however, included in the final statistical analysis. As a result, this study design allows the findings to be applied to everyday practice.

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