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

In a study conducted by Aurélien Dinh and team, it was found that only male sex and age were linked with a greater risk of failure among patients with community-acquired pneumonia (CAP) who attained clinical stabilization after 3 days of antibiotic therapy, regardless of antibiotic treatment duration and biomarker levels.

In the United States, up to 5.6 million episodes of community-acquired pneumonia (CAP) occur each year1, resulting in 600,000 to 800,000 hospitalizations, with elderly patients having the greatest incidence rate.

The objective of this study was to identify possible risk factors for therapy failure in clinically stable CAP patients.

The findings of this study were published online in Journal of American Medical Association Network on 15th October, 2021.

This secondary analysis looks at data from a randomized clinical study on CAP (Pneumonia Short Treatment [PTC] trial) that took place between December 19, 2013, and February 1, 2018. The data was analyzed between July 18, 2019, and February 15, 2020. Patients admitted to one of 16 French hospitals with moderately severe CAP and clinically stable on day three of antibiotic therapy were included in the PTC study and assessed in the per-protocol trial population. On day 3 of antibiotic treatment, patients were randomly allocated (1:1) to receive -lactam (amoxicillin-clavulanate [1 g/125 mg] 3 times daily) or placebo for 5 days.

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