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- Title
1g versus 2 g daily intravenous ceftriaxone in the treatment of community onset pneumonia - a propensity score analysis of data from a Japanese multicenter registry.
- Authors
Hasegawa, Shinya; Sada, Ryuichi; Yaegashi, Makito; Morimoto, Konosuke; Mori, Takahiro; on behalf of the Adult Pneumonia Study Group-Japan; Abe, Masahiko; Wakabayashi, Takao; Aoshima, Masahiro; Hosokawa, Naoto; Kaneko, Norihiro; Katsurada, Naoko; Nakashima, Kei; Otsuka, Yoshihito; Sando, Eiichiro; Shibui, Kaori; Suzuki, Daisuke; Tanaka, Kenzo; Tochitani, Kentaro; Chikamori, Masayuki
- Abstract
<bold>Background: </bold>Community-onset pneumonia (COP) is a combined concept of community acquired pneumonia and the previous classification of healthcare-associated pneumonia. Although ceftriaxone (CRO) is one of the treatment choices for COP, it is unclear whether 1 or 2 g CRO daily has better efficacy. We compared the effectiveness of 1 g with 2 g of CRO for COP treatment. We hypothesized that 1 g CRO would show non-inferiority over 2 g CRO.<bold>Methods: </bold>This study was an analysis of prospectively registered data of the patients with COP from four Japanese hospitals (the Adult Pneumonia Study Group-Japan: APSG-J). We included subjects who were initially treated solely with 1 or 2 g of CRO. The propensity score was estimated from the 33 pre-treatment variables, including age, sex, weight, pre-existing comorbidities, prescribed drugs, risk factors for aspiration pneumonia, vital signs, laboratory data, and a finding from chest xrays. The primary endpoint was the cure rate, for which a non-inferiority analysis was performed with a margin of 0.05. In addition, we performed three sensitivity analyses; using data limited to the group in which CRO solely was used until the completion of treatment, using data limited to inpatient cases, and performing a generalized linear mixed-effect logistic regression analysis to assess the primary outcome after adjusting for random hospital effects.<bold>Results: </bold>Of the 3817 adult subjects with pneumonia who were registered in the APSG-J study, 290 and 216 were initially treated solely with 1 or 2 g of CRO, respectively. Propensity score matching was used to extract 175 subjects in each group. The cure rate was 94.6 and 93.1% in the 1 and 2 g CRO groups, respectively (risk difference 1.5%; 95% confidence interval - 3.1 to 6.0; p = 0.009 for non-inferiority). The results of the sensitivity analyses were consistent with the primary result.<bold>Conclusions: </bold>The propensity score-matched analysis of multicenter cohort data from Japan revealed that the cure rate for COP patients treated with 1 g daily CRO was non-inferior to that of patients treated with 2 g daily CRO.
- Subjects
JAPAN; CEFTRIAXONE; COMMUNITY-acquired pneumonia; DATA analysis; PNEUMONIA; PROPENSITY score matching; ASPIRATION pneumonia; LOGISTIC regression analysis
- Publication
BMC Infectious Diseases, 2019, Vol 19, Issue 1, p1
- ISSN
1471-2334
- Publication type
journal article
- DOI
10.1186/s12879-019-4552-8