Comparison of fluorokinolon only against ampicilline/ sulbactam and macrolide combination at cases of community-acquired pneumonia requiring hospitalization

Community acquired pneumonia (CAP ) is a common and serious health problem all over the world. Initiation of appropriate antibiotic therapy immediate after the diagnosis has been shown to affect mortality. Delayed treatment of pneumonia is known to increase mortality and morbidity. Results of treatment with ampicilline/sulbactam and macrolide (AS ± M) combination and fluorokinolon at community-acquired pneumonia (TGP) are controversial. For this purpose, we retrospectively assessed patients who has been hospitalized in Chest Disease Clinic of Akdeniz University Hospital due to CAP between October 2009 and May 2012. The aim of this study is to compare age, sex, demographics, risk factors, comorbid diseases, PSI and CURB-65 scores, treatment outcome, duration of hospitalization, treatment costs, the early and late mortality, efficacy of treatment with AS ± M combination and F monotherapy at patients with CAP requiring hospitalization. In this study, 225 patients with community-acquired pneumonia were included. Of the total 225 pneumonia cases, 123 (54.6%) was AS ± M and 75 (33.3%) was F treated. 77 (34.2%) were women, 148 (65.8%) were men. Mean age was 66 years. The most common diseases were diabetes mellitus, chronic obstructive pulmonary disease and cardiovascular disease of the patients. The initial symptoms were cough, sputum, fever and dyspnea. Severity of disease at referral, age, sex, comorbid diseases, smoking status, laboratory findings, CURB-65 and PSI scores were similar at both groups. In our study, all patients chest X-ray had multilobar infiltration, bilateral involvement and pleural effusion at a similar rate between the groups. There were no differences in laboratory findings between the groups. Our patients influenza vaccination rate were 15.4% at AS ± M group, 20% at group F. AS ± M group 6.5%, F group 8% were vaccinated with pneumococcal vaccine. The predominantly isolated microorganism were S.pneumonia, Klebsiella species, Pseudomonas aeruginosa, Moraxella catarrhalis. Among patients evaluable for clinical efficacy, 88% of levofloxacin-treated patients and 82.1% of comparator-treated patients achieved clinical success (p=0.314). 30-day mortality was 8.1% at AS ± M group, 8% at F group, 90-day mortality was 12.2% AS ± M, F group 11.8%, 1-year mortality was AS ± M group 11.4%, F group was 7.9%. Mean cost of hospitalization was 1963±3723 TL for AS ± M group and 1965±7172 TL for F group. There were no differences between two groups about stay at hospital (5.6±3.9 days at AS±M groups, 5.9±3.9 days at F groups), mortality rates and hospital costs. In conclusion, the patients were given combination therapy or fluorokinolon; there was not a statistically difference in age, sex, comorbid diseases, PSI and CURB-65 scores, early and late mortality, length of stay and cost of treatment