Effect of macrolides as part of initial empiric therapy on length of stay in patients hospitalized with community-acquired pneumonia

Background: The choice of antibiotics to treat community-acquired pneumonia (CAP) is primarily empiric, and the effect of this choice on length of sta y (LOS) and mortality is largely unknown. Objective: To examine the impact of antibiotic choice on these outcomes in general medical patients hospitalized with CAP. Methods: One hundred patients hospitalized with CAP were prospectively iden tified. Seventy-six met inclusion criteria and were entered into the study. After hospital discharge, each medical chart was examined by 2 independent physicians who verified the admitting diagnosis and entered the data for a ntimicrobial regimens, a CAP mortality prediction tool, a social and dispos ition index, and other health outcomes. Patients were stratified according to the antibiotic received. Simple regression techniques were used to exami ne the correlation between initial therapy, specifically, ceftriaxone sodiu m or a macrolide, and LOS and mortality. Results: Patients who received macrolides within the first 24 hours of admi ssion had a markedly shorter LOS (2.8 days) than those not so treated (5.3 days; P =.01). This effect diminished as the interval before administering macrolides increased. Including ceftriaxone as part of the initial therapy did not appear to affect LOS. Patients given a macrolide for initial treatm ent did not differ significantly from those not treated in terms of mean ag e, mortality prediction tool score, or Social and Disposition Index score. Eleven of the 12 patients who received macrolides also received a beta-lact am antibiotic. Conclusion: Use of macrolides as part of an initial therapeutic regimen app ears to be associated with shorter LOS.