Community-acquired Pneumonia

• Objective: To evaluate the efficacy and safety of oral cefpodoxime compared with parenteral ceftriaxone in the treatment of community-acquired pneumonia (CAP) requiring hospitalization. • Design: Prospective, randomized, double-blind, multicenter trial. • Patients and setting: Patients aged 18 years or older with acute signs and symptoms of CAP requiring hospitalization at 10 U.S. medical centers and private practices. • Interventions: Oral cefpodoxime 200 mg twice daily and placebo infusion of 0.9% sodium chloride or parenteral (intravenous or intramuscular) ceftriaxone 1 g daily and oral placebo for 7 to 14 days. • Main outcome measures: Bacteriologic and clinical response rates at end of therapy. • Results: Of the 85 patients enrolled in the trial, 44 received oral cefpodoxime and 41 received parenteral ceftriaxone. Bacterial eradication rates were 100% in both treatment groups. Fifty-nine of the 85 patients (69%) were considered clinically assessable. Of the 33 clinically assessable patients in the cefpodoxime group, 20 (60.6%) were clinically cured, 8 (24.2%) were improved, and 5 (15.2%) were failures. Of the 26 clinically assessable patients in the ceftriaxone group, 15 (57.7%) were clinically cured, 6 (23.1%) were improved, and 5 (19.2%) were failures. A total of 45.5% of patients in the cefpodoxime group and 46.3% of those in the ceftriaxone group reported adverse events, most of which were mild. Drug-related diarrhea occurred in 6 ceftriaxone patients but not in the cefpodoxime group. Three patients treated with cefpodoxime and 2 receiving ceftriaxone withdrew from the study because of adverse events. • Conclusion: Oral cefpodoxime is as safe and effective as parenteral ceftriaxone in the treatment of CAP requiring hospitalization. Introduction Each year, approximately 12 of every 1000 adults in the United States contract pneumonia, amounting to nearly 4 million cases of pneumonia annually [1]. More than 600,000 of these patients require hospitalization at a treatment cost of $23 billion [1]. Immediate parenteral therapy with an antibiotic is the usual treatment regimen for hospitalized patients. Many physicians prescribe intravenous (IV) therapy for 7 to 10 days; some switch to oral drugs after the patient has been stabilized to complete the course [2]. The average length of stay for patients with pneumonia is 8.3 days [3]. Pressures to contain costs combined with the availability of newer, more potent oral agents has led to a growing interest in oral therapy for community-acquired pneumonia (CAP). Recently, the Infectious Diseases Society of America (IDSA) endorsed oral therapy for those patients who can tolerate it, noting that there are no studies showing superior outcomes of parenteral administration compared with the oral route [4]. In addition, oral medications are more easily administered, less costly, and may permit earlier discharge from the hospital.