Older males more prone to treatment failure in CAP after early stability with antibiotics: JAMA

In this study only male sex and age were linked with a greater probability of failure in this secondary analysis of a randomized clinical trial of patients with CAP who attained clinical stabilization after 3 days of antibiotic therapy. The median age of the CAP population is commonly stated as being between 70 and 74 years old, with the majority being male and having a high number of comorbidities such as diabetes, chronic obstructive lung disease, chronic heart failure, and a PSI score of III to IV. Only a handful of these risk variables were significant in the current analysis, presumably because only patients with CAP who obtained clinical stabilization on day 3 were included. Patients who had 3 or 8 days of -lactam treatment had the same cure rate. From day 0 to day 3, all patients in this research exhibited comparable CAP score evolutions. The CAP score on day 0 was not linked to failure. Patients identified as experiencing treatment failure on day 15 had lower CAP ratings for each respiratory symptom on day 8 and day 15.

In conclusion, age and gender, but not comorbidities or illness severity, were linked with an increased chance of failure among patients with CAP who satisfied the criteria for stability after 3 days of antibiotic therapy. The value of clinical sign surveillance cannot be overstated. These findings should be considered in the management of CAP patients.

Reference:

Dinh A, Duran C, Ropers J, et al. Factors Associated with Treatment Failure in Moderately Severe Community-Acquired Pneumonia: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021;4(10):e2129566.

doi:10.1001/jamanetworkopen.2021.29566