Comparative Safety of Different Antibiotic Regimens For the Treatment of Outpatient Community-Acquired Pneumonia Among Otherwise Healthy Adults.

Details

• Alternative Title:
  Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 2026, v. 81, no. 6: Comparative Safety of Different Antibiotic Regimens For the Treatment of Outpatient Community-Acquired Pneumonia Among Otherwise Healthy Adults.
• Journal Article:
  Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America
• Personal Author:
  Butler, Anne M. ; Nickel, Katelin B. ; Olsen, Margaret A. ; Sahrmann, John M. ; Colvin, Ryan ; Neuner, Elizabeth ; O'Neil, Caroline A. ; Fraser, Victoria J. ; Durkin, Michael J.
• Description:
  Evidence is limited on the comparative safety of antibiotic regimens for treatment of community-acquired pneumonia (CAP). We compared the risk of adverse drug events (ADEs) associated with antibiotic regimens for CAP treatment among otherwise healthy, nonelderly adults.
  
  We conducted an active-comparator new-user cohort study (2007-2019) of commercially insured adults aged 18-64 years diagnosed with outpatient CAP, evaluated via chest X-ray, and dispensed a same-day CAP-related oral antibiotic regimen. ADE follow-up duration ranged from 2 to 90 days (eg, renal failure 14 days). We estimated risk differences RDs per 1000 treatment episodes and risk ratios using propensity score-weighted Kaplan-Meier functions. Ankle/knee sprain and influenza vaccination were considered as negative control outcomes.
  
  Of 145 137 otherwise healthy CAP patients without comorbidities, 52% received narrow-spectrum regimens (44% macrolide, 8% doxycycline) and 48% received broad-spectrum regimens (39% fluoroquinolone, 7% β-lactam, 3% β-lactam + macrolide). Compared with macrolide monotherapy, each broad-spectrum antibiotic regimen was associated with increased risk of several ADEs (eg, β-lactam: nausea/vomiting/abdominal pain RD per 1000, 3.20; 95% CI, 0.99-5.73; non-Clostridioides difficile diarrhea RD per 1000, 4.61; 95% CI, 2.47-6.82; vulvovaginal candidiasis/vaginitis RD per 1000, 3.57; 95% CI, 0.87, 6.88). Narrow-spectrum antibiotic regimens largely conferred similar risk of ADEs. We generally observed similar risks of each negative control outcome, indicating minimal confounding.
  
  Broad-spectrum antibiotics were associated with increased risk of ADEs among otherwise healthy adults treated for CAP in the outpatient setting. Antimicrobial stewardship is needed to promote judicious use of broad-spectrum antibiotics and ultimately decrease antibiotic-related ADEs.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Community-Acquired Infections
  • Adult
  • Anti-Bacterial Agents
  • Female
  • Male
  • Middle Aged
  • Young Adult
  • Adolescent
  • Pneumonia
  More +
• Keywords:
  • administrative data
  • adverse drug events
  • antibiotic safety
  • antimicrobial stewardship
  • community-acquired pneumonia
• Source:
  Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 2026, v. 81, no. 6
• DOI:
  https://doi.org/10.1093/cid/ciae519
• ISSN:
  1058-4838 ; 1537-6591
• Pubmed ID:
  39442057
• Pubmed Central ID:
  PMC12355227
• Document Type:
  Text
• Funding:
  KL2 TR002346/TR/NCATS NIH HHSUnited States/ ; R24 HS019455/HS/AHRQ HHSUnited States/ ; U54 CK000609/CK/NCEZID CDC HHSUnited States/ ; UL1 TR002345/TR/NCATS NIH HHSUnited States/ ; U54CK000609/Centers for Disease Control and Prevention, Prevention Epicenters/ ; TR/NCATS NIH HHSUnited States/ ; KL2TR002346/(NCATS)/ ; UL1 TR002345/TR/NCATS NIH HHSUnited States/ ; R24 HS19455/NH/NIH HHSUnited States/ ; HS/AHRQ HHSUnited States/
• Genre:
  Journal Article
• Pages in Document:
  1141-1151 (18 pdf pages)
• Volume:
  81
• Issue:
  6
• Download URL:
  https://stacks.cdc.gov/view/cdc/261959/cdc_261959_DS1.pdf
• File Type:
  [PDF - 930.47 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:a64bcd7e56a8569b86d5ffb86e0706d4994b7f025d0f213f3cae2217ed18bf71a70f813ea6ca3273aa4b11cc5fcb3d9a3426cfba5ff49709225c0e9d5e177ee6