Community-acquired pneumonia (CAP) is one of the most common infectious diseases and is an important cause of mortality and morbidity worldwide. The prognosis of CAP in adults is associated with factors such as age, comorbidities, vital signs, laboratory data and other factors on admission. Usually, ceftriaxone (CTRX) is used to treat CAP. However, whether 1 or 2g of CTRX daily has better efficacy remains unclear.
This study is an analysis of prospectively registered data from 4 Japanese hospitals for patients with community-onset pneumonia (COP) from September 2011 to August 2014 (the Adult Pneumonia Study Group-Japan: APSG-J). Subjects who were initially treated solely with 1g or 2g of CTRX were enrolled. Propensity score was estimated from the 33 pretreatment variables including age, sex, weight, comorbidities, medications, risk factors for aspiration, whether background was consistent with CAP or not, vital signs, laboratory data, and findings of a chest x-ray. The primary endpoint was cure rate, for which a noninferiority analysis was performed with a margin of 0.05. The secondary outcomes included in-hospital mortality, duration of antibiotic treatment, and length of hospital stay, which were assessed using superiority analyses.
Of the 3,817 adult subjects with pneumonia who were registered in the APSG-J study, 290 and 216 were initially treated solely with 1g or 2g of CTRX, respectively. Propensity score matching was used to finally extract 175 subjects in each group. Overall, the cure rate was 94.6% in the 1g group and 93.1% in the 2g group (risk difference, 1.5 percentage points; 95% confidence interval [CI], −3.1 to 6.0; p = 0.009 for noninferiority). The in-hospital mortality rate was 4.7% and 4.0% (p = 0.740 for superiority), length of hospital stay was 17 and 26 days (p < 0.001 for superiority), and duration of antibiotic treatment was 8 and 10 days (p = 0.002 for superiority) in the 1g and 2g groups, respectively.
Propensity score-matched analysis of multicenter cohort data from Japan revealed that the cure rate for COP patients treated with 1g of CTRX was non-inferior to that in the patients treated with 2g of CTRX.
M. Yaegashi, None
T. Mori, None