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  • Comparing the Efficacy of Different Antibiotic Regimens in Treating Community-Acquired Pneumonia: A Prospective Observational Study

  • Vels Institute of Science, Technologies & Advanced Studies, P.V Vaithiyalingam road, old Pallavaram, Chennai-600117, Tamilnadu, India.

Abstract

Community-acquired pneumonia (CAP) continues to represent a significant cause of morbidity and mortality worldwide. Antibiotic therapy is fundamental to its management, with various regimens incorporating beta-lactams, macrolides, and fluoroquinolones frequently utilized. This prospective observational study aimed to evaluate the efficacy of three distinct antibiotic regimens in the treatment of CAP. A total of 96 patients diagnosed with CAP were enrolled and divided equally into three groups: beta-lactam, macrolide, and fluoroquinolone. The study was conducted over six months and assessed clinical outcomes, including fever resolution, length of hospital stay, and adverse effects, in conjunction with patient demographics. The findings suggest that while all regimens demonstrated effectiveness, notable differences in patient outcomes were observed, underscoring the necessity for tailored treatment strategies.

Keywords

Community-acquired pneumonia, beta-lactam antibiotics, macrolides, fluoroquinolones, antibiotic efficacy, observational study

Introduction

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Community-acquired pneumonia (CAP) represents a significant global health concern. It is a leading cause of hospitalization and mortality, particularly among the elderly and individuals with comorbidities. Antibiotics serve as the primary treatment for CAP, with a variety of regimens available for consideration. The selection of an appropriate antibiotic is influenced by several factors, including the severity of the infection, the patient's underlying health conditions, and local resistance patterns. This study aims to compare the efficacy of three commonly used classes of antibiotics: beta-lactams, macrolides, and fluoroquinolones, in the treatment of CAP.

  1. Methodology:
    1. Study Design

This observational study was carried out over a duration of six months. The aim was to assess the effectiveness of three different antibiotic treatment regimens for patients diagnosed with community-acquired pneumonia..

    1. Study Population

This Study included 96 patients who were diagnosed with community-acquired pneumonia (CAP). These patients were randomly assigned to one of three treatment groups:

      • Group 1: Beta-lactam antibiotics (e.g., amoxicillin or ceftriaxone)
      • Group 2: Macrolide antibiotics (e.g., azithromycin or clarithromycin)
      • Group 3: Fluoroquinolone antibiotics (e.g., levofloxacin or moxifloxacin) Each group consisted of 32 patients..
    • Inclusion Criteria
      • Adult patients between the ages of 18 and 80.
      • A clinical diagnosis of community-acquired pneumonia, validated through chest X-ray or CT imaging.
      • Absence of significant allergies or contraindications to the prescribed antibiotics.

2.4 Exclusion Criteria

  • Patients with hospital-acquired pneumonia.
  • Immunocompromised individuals.
  • Pregnant or breastfeeding women.
  • Patients with chronic pulmonary conditions such as advanced COPD.

2.5 Demographics

The study included a diverse sample in terms of age, gender, and comorbid conditions:

  • Age Range: 18-80 years, mean: 56.4 ± 12.3 years.
  • Gender Distribution: 55% males, 45% females.
  • Comorbidities: 40% of patients had at least one comorbidity (e.g., diabetes, hypertension, COPD).

2.6 Intervention

The antibiotic regimens were administered according to standard clinical guidelines:

  • Beta-lactam group: Ceftriaxone 1g IV daily for 7 days.
  • Macrolide group: Azithromycin 500mg IV daily for 5 days.
  • Fluoroquinolone group: Levofloxacin 500mg IV daily for 7 days.

2.7 Outcome Measures

The primary outcomes assessed included:

  • Clinical Resolution: Time to fever resolution (days).
  • Length of Hospital Stay (LOS): Calculated from the time of admission to discharge.
  • Adverse Effects: Any side effects observed throughout the treatment process.

Secondary outcomes included:

  • Mortality statistics
  • Requirement for increased therapeutic intervention
    1. Statistical Analysis

Descriptive statistics along with comparative analyses, including ANOVA and chi-square tests, were employed to analyze the data. A p-value of less than 0.05 was established as the threshold for statistical significance.

  1. Results:
    1. Patient Demographics
      • Beta-lactam group: Mean age 55.2 ± 13.1 years, 60% males.
      • Macrolide group: Mean age 57.3 ± 11.2 years, 50% males.
      • Fluoroquinolone group: Mean age 58.1 ± 12.4 years, 52% males.
    2. Clinical Outcomes
  • Fever Resolution:
  • Beta-lactam: 3.2 ± 1.1 days
  • Macrolide: 3.5 ± 1.3 days
  • Fluoroquinolone: 2.9 ± 1.0 days

Fluoroquinolones showed the fastest fever resolution.

  • Length of Hospital Stay:
  • Beta-lactam: 6.1 ± 1.5 days
  • Macrolide: 6.5 ± 2.1 days
  • Fluoroquinolone: 5.8 ± 1.3 days

Fluoroquinolone group had the shortest LOS.

    1. Adverse Effects
      • Beta-lactam group: 4 patients (12.5%) reported mild gastrointestinal discomfort.
      • Macrolide group: 5 patients (15.6%) experienced mild gastrointestinal upset.
      • Fluoroquinolone group: 3 patients (9.4%) reported dizziness and nausea.

There were no severe adverse effects or discontinuations due to side effects in any group.

    1. Mortality and Escalation of Therapy

During the trial, no patients passed away. However, because of their inadequate response, two patients in the macrolide group needed their medication to be escalated.

  1. DISCUSSION:

This research indicated that all three antibiotic treatment regimens were successful in managing community-acquired pneumonia. Nonetheless, variations were observed in the duration until fever resolution, length of hospital stay, and occurrence of side effects. Fluoroquinolones were linked to a quicker alleviation of symptoms and a reduced hospital stay, highlighting their potential advantages in more severe cases. Beta-lactams also proved effective, exhibiting fewer side effects, although they resulted in slightly longer recovery periods compared to fluoroquinolones.

Macrolides demonstrated effectiveness as well; however, their marginally higher rate of adverse effects and extended recovery times suggest they may not be the optimal first-line option for all patients, particularly those with more severe conditions.

The study underscores the necessity of choosing antibiotics based on patient characteristics, pneumonia severity, and local resistance patterns. Additional large-scale research is required to confirm these results and to investigate the cost-effectiveness and resistance trends associated with these antibiotics in the management of community-acquired pneumonia.

  1. CONCLUSION:

The findings from this prospective observational study indicate that beta-lactams, macrolides, and fluoroquinolones are all effective in the treatment of community-acquired pneumonia. However, fluoroquinolones demonstrate benefits such as faster symptom resolution and reduced hospital duration. This could position fluoroquinolones as a more suitable choice for patients with severe cases of CAP. Nonetheless, it is essential to take into account patient demographics, existing comorbidities, and possible adverse effects when determining the appropriate antibiotic treatment plan.

Declarations

Funding

No funding was received for this review article.

Conflicts of Interest

The authors declare no conflicts of interest.

Ethics Approval

Got Approval from Institutional Ethical Committee. And certificate is attached below.

REFERENCES

  1. Postma DF, Van Werkhoven CH, Van Elden LJ, Thijsen SF, Hoepelman AI, Kluytmans JA, Boersma WG, Compaijen CJ, Van Der Wall E, Prins JM, Oosterheert JJ. Antibiotic treatment strategies for community-acquired pneumonia in adults. New England Journal of Medicine. 2015 Apr 2;372(14):1312-23.
  2. Uranga A, España PP, Bilbao A, Quintana JM, Arriaga I, Intxausti M, Lobo JL, Tomás L, Camino J, Nuñez J, Capelastegui A. Duration of antibiotic treatment in community-acquired pneumonia: a multicenter randomized clinical trial. JAMA internal medicine. 2016 Sep 1;176(9):1257-65.
  3. Kaal AG, Roos R, de Jong P, Pepping RM, van den Berg JM, van Aken MO, Steyerberg EW, Numans ME, van Nieuwkoop C. Oral versus intravenous antibiotic treatment of moderate-to- severe community-acquired pneumonia: a propensity score matched study. Scientific Reports. 2024 Apr 9;14(1):8271.
  4. Falguera M, Ruiz-González A, Schoenenberger JA, Touzon C, Gázquez I, Galindo C, Porcel JM. Prospective, randomised study to compare empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalised patients with community-acquired pneumonia. Thorax. 2010 Feb 1;65(2):101-6.
  5. Al-Salloum J, Gillani SW, Mahmood RK, Gulam SM. Comparative efficacy of azithromycin versus clarithromycin in combination with beta-lactams to treat community-acquired pneumonia in hospitalized patients: A systematic review. Journal of International Medical Research. 2021 Oct;49(10):03000605211049943.
  6. Choi SH, Cesar A, Snow TA, Saleem N, Arulkumaran N, Singer M. Efficacy of doxycycline for mild-to-moderate community-acquired pneumonia in adults: a systematic review and meta- analysis of randomized controlled trials. Clinical Infectious Diseases. 2023 Feb 15;76(4):683-91.
  7. Yadegarynia D, Tehrani S, Maghsoudi FN, Shojaeian F, Keyvanfar A. Levofloxacin versus ceftriaxone and azithromycin for treating community-acquired pneumonia: a randomized clinical trial study. Iranian Journal of Microbiology. 2022 Aug;14(4):458.
  8. Furukawa Y, Luo Y, Funada S, Onishi A, Ostinelli E, Hamza T, Furukawa TA, Kataoka Y. Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis. BMJ open. 2023 Mar 1;13(3):e061023.
  9. Israelsen SB, Tingsgård S, Thorlacius-Ussing L, Knudsen A, Lindegaard B, Johansen IS, Mygind LH, Ravn P, Benfield T. Short-course antibiotic therapy of 5 days in community- acquired pneumonia (CAP5): study protocol for a randomised controlled trial. BMJ open. 2023 Jul 1;13(7):e069013.
  10. Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. The Lancet. 2015 Sep 12;386(9998):1097-108.
  11. Fee, C., Mace, S.E., Maughan, B., JC, J.P., Kaji, A. and Wolf, S.J., 2020. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency 1 Department With Community-Acquired Pneumonia 2 This DRAFT is EMBARGOED− Not for Distribution 3. Annals of Emergency Medicine, 33, p.34.
  12. Martin-Loeches I, Torres A, Nagavci B, Aliberti S, Antonelli M, Bassetti M, Bos LD, Chalmers JD, Derde L, De Waele J, Garnacho-Montero J. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive care medicine. 2023 Jun;49(6):615-32.
  13. Zhang Y, Zhang F, Wang H, Zhao C, Wang Z, Cao B, Du Y, Feng X, Hu Y, Hu B, Ji P. Antimicrobial susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolated from community-acquired respiratory tract infections in China: Results from the CARTIPS Antimicrobial Surveillance Program. Journal of global antimicrobial resistance. 2016 Jun 1;5:36-41..
  14. Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive care medicine. 2020 May;46(5):888-906.
  15. Dinh A, Duran C, Ropers J, Bouchand F, Deconinck L, Matt M, Senard O, Lagrange A, Mellon G, Calin R, Makhloufi S. Exclusive oral antibiotic treatment for hospitalized community- acquired pneumonia: a post-hoc analysis of a randomized clinical trial. Clinical Microbiology and Infection. 2024 May 9.
  16. Montes-Andujar L, Tinoco E, Baez-Pravia O, Martin-Saborido C, Blanco-Schweizer P, Segura C, Silva EP, Reyes V, Cobo AR, Zurdo C, Angel V. Empiric antibiotics for community- acquired pneumonia in adult patients: a systematic review and a network meta-analysis. Thorax. 2021 Oct 1;76(10):1020-31.
  17. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003 May;58(5):377-82. doi: 10.1136/thorax.58.5.377. PMID: 12728155; PMCID: PMC1746657.
  18. Butler AM, Nickel KB, Olsen MA, Sahrmann JM, Colvin R, Neuner E, O’Neil CA, Fraser VJ, Durkin MJ. Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults. Clinical Infectious Diseases. 2024 Oct 23:ciae519.
  19. Nair GB, Niederman MS. Updates on community acquired pneumonia management in the ICU. Pharmacology & therapeutics. 2021 Jan 1;217:107663.
  20. Caballero LA, Aijaz A, Paryani NS, Mahmood S, Salman M, Khan MO, Ahluwalia D, Siddiq MA, Hameed I. Comparing the efficacy of corticosteroids among patients with community- acquired pneumonia in the ICU versus non-ICU settings: A systematic review and meta-analysis. Steroids. 2024 Feb 13:109389.
  21. Williams DJ, Creech CB, Walter EB, Martin JM, Gerber JS, Newland JG, Howard L, Hofto ME, Staat MA, Oler RE, Tuyishimire B. Short-vs standard-course outpatient antibiotic therapy for community-acquired pneumonia in children: the SCOUT-CAP randomized clinical trial. JAMA pediatrics. 2022 Mar 1;176(3):253-61.
  22. Vaughn VM, Dickson RP, Horowitz JK, Flanders SA. Community-Acquired Pneumonia: A Review. Jama. 2024.
  23. Mukanhaire L, Li H, Fan Z, Yang L, Zheng Y, Ran Z, Zong X, Zhang L, Gong Y, Yang C, Gong JT. Efficacy of corticosteroids as an adjunctive therapy in the treatment of community- acquired pneumonia: a systematic review and meta-analysis. Acta Materia Medica. 2023 Jan 10;2(1):9-22
  24. Bielicki JA, Stöhr W, Barratt S, Dunn D, Naufal N, Roland D, Sturgeon K, Finn A, Rodriguez-Ruiz JP, Malhotra-Kumar S, Powell C. Effect of amoxicillin dose and treatment duration on the need for antibiotic re-treatment in children with community-acquired pneumonia: the CAP-IT randomized clinical trial. Jama. 2021 Nov 2;326(17):1713-24.
  25. Nakagawa Y, Kato H, Iwamoto T. Investigation of antimicrobial therapy for aspiration pneumonia in elderly nursing homes: a retrospective observational study in Japan. Pharmacy Practice. 2023 Sep 27;21(3):1-0.
  26. Martin-Loeches I, Garduno A, Povoa P, Nseir S. Choosing antibiotic therapy for severe community-acquired pneumonia. Current Opinion in Infectious Diseases. 2022 Apr 1;35(2):133- 9.
  27. Gao Y, Liu M, Yang K, Zhao Y, Tian J, Pernica JM, Guyatt G. Shorter versus longer-term antibiotic treatments for community-acquired pneumonia in children: a meta-analysis. Pediatrics. 2023 Jun 1;151(6):e2022060097.
  28. Bassetti M, Giacobbe DR, Magnasco L, Fantin A, Vena A, Castaldo N. Antibiotic Strategies for Severe Community-Acquired Pneumonia. InSeminars in Respiratory and Critical Care Medicine 2024 Feb 1. Thieme Medical Publishers, Inc..
  29. Uryasev OM, Shakhanov AV, Korshunova LV. Effectiveness of antimicrobial therapy for community-acquired pneumonia in real clinical practice. BULLETIN OF SIBERIAN MEDICINE. 2021 Dec 29;20(4):79-85.
  30. Scalera NM, File TM. Determining the duration of therapy for patients with community- acquired pneumonia. Current infectious disease reports. 2013 Apr;15:191-5.
  31. Bender MT, Niederman MS. Principles of antibiotic management of community-acquired pneumonia. InSeminars in Respiratory and Critical Care Medicine 2016 Dec (Vol. 37, No. 06, pp. 905-912). Thieme Medical Publishers.
  32. Niederman MS, Torres A. Severe community-acquired pneumonia. European Respiratory Review. 2022 Dec 31;31(166).
  33. Leung AK, Wong AH, Hon KL. Community-acquired pneumonia in children. Recent patents on inflammation & allergy drug discovery. 2018 Oct 1;12(2):136-44

Reference

  1. Postma DF, Van Werkhoven CH, Van Elden LJ, Thijsen SF, Hoepelman AI, Kluytmans JA, Boersma WG, Compaijen CJ, Van Der Wall E, Prins JM, Oosterheert JJ. Antibiotic treatment strategies for community-acquired pneumonia in adults. New England Journal of Medicine. 2015 Apr 2;372(14):1312-23.
  2. Uranga A, España PP, Bilbao A, Quintana JM, Arriaga I, Intxausti M, Lobo JL, Tomás L, Camino J, Nuñez J, Capelastegui A. Duration of antibiotic treatment in community-acquired pneumonia: a multicenter randomized clinical trial. JAMA internal medicine. 2016 Sep 1;176(9):1257-65.
  3. Kaal AG, Roos R, de Jong P, Pepping RM, van den Berg JM, van Aken MO, Steyerberg EW, Numans ME, van Nieuwkoop C. Oral versus intravenous antibiotic treatment of moderate-to- severe community-acquired pneumonia: a propensity score matched study. Scientific Reports. 2024 Apr 9;14(1):8271.
  4. Falguera M, Ruiz-González A, Schoenenberger JA, Touzon C, Gázquez I, Galindo C, Porcel JM. Prospective, randomised study to compare empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalised patients with community-acquired pneumonia. Thorax. 2010 Feb 1;65(2):101-6.
  5. Al-Salloum J, Gillani SW, Mahmood RK, Gulam SM. Comparative efficacy of azithromycin versus clarithromycin in combination with beta-lactams to treat community-acquired pneumonia in hospitalized patients: A systematic review. Journal of International Medical Research. 2021 Oct;49(10):03000605211049943.
  6. Choi SH, Cesar A, Snow TA, Saleem N, Arulkumaran N, Singer M. Efficacy of doxycycline for mild-to-moderate community-acquired pneumonia in adults: a systematic review and meta- analysis of randomized controlled trials. Clinical Infectious Diseases. 2023 Feb 15;76(4):683-91.
  7. Yadegarynia D, Tehrani S, Maghsoudi FN, Shojaeian F, Keyvanfar A. Levofloxacin versus ceftriaxone and azithromycin for treating community-acquired pneumonia: a randomized clinical trial study. Iranian Journal of Microbiology. 2022 Aug;14(4):458.
  8. Furukawa Y, Luo Y, Funada S, Onishi A, Ostinelli E, Hamza T, Furukawa TA, Kataoka Y. Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis. BMJ open. 2023 Mar 1;13(3):e061023.
  9. Israelsen SB, Tingsgård S, Thorlacius-Ussing L, Knudsen A, Lindegaard B, Johansen IS, Mygind LH, Ravn P, Benfield T. Short-course antibiotic therapy of 5 days in community- acquired pneumonia (CAP5): study protocol for a randomised controlled trial. BMJ open. 2023 Jul 1;13(7):e069013.
  10. Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. The Lancet. 2015 Sep 12;386(9998):1097-108.
  11. Fee, C., Mace, S.E., Maughan, B., JC, J.P., Kaji, A. and Wolf, S.J., 2020. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency 1 Department With Community-Acquired Pneumonia 2 This DRAFT is EMBARGOED− Not for Distribution 3. Annals of Emergency Medicine, 33, p.34.
  12. Martin-Loeches I, Torres A, Nagavci B, Aliberti S, Antonelli M, Bassetti M, Bos LD, Chalmers JD, Derde L, De Waele J, Garnacho-Montero J. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive care medicine. 2023 Jun;49(6):615-32.
  13. Zhang Y, Zhang F, Wang H, Zhao C, Wang Z, Cao B, Du Y, Feng X, Hu Y, Hu B, Ji P. Antimicrobial susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolated from community-acquired respiratory tract infections in China: Results from the CARTIPS Antimicrobial Surveillance Program. Journal of global antimicrobial resistance. 2016 Jun 1;5:36-41..
  14. Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive care medicine. 2020 May;46(5):888-906.
  15. Dinh A, Duran C, Ropers J, Bouchand F, Deconinck L, Matt M, Senard O, Lagrange A, Mellon G, Calin R, Makhloufi S. Exclusive oral antibiotic treatment for hospitalized community- acquired pneumonia: a post-hoc analysis of a randomized clinical trial. Clinical Microbiology and Infection. 2024 May 9.
  16. Montes-Andujar L, Tinoco E, Baez-Pravia O, Martin-Saborido C, Blanco-Schweizer P, Segura C, Silva EP, Reyes V, Cobo AR, Zurdo C, Angel V. Empiric antibiotics for community- acquired pneumonia in adult patients: a systematic review and a network meta-analysis. Thorax. 2021 Oct 1;76(10):1020-31.
  17. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003 May;58(5):377-82. doi: 10.1136/thorax.58.5.377. PMID: 12728155; PMCID: PMC1746657.
  18. Butler AM, Nickel KB, Olsen MA, Sahrmann JM, Colvin R, Neuner E, O’Neil CA, Fraser VJ, Durkin MJ. Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults. Clinical Infectious Diseases. 2024 Oct 23:ciae519.
  19. Nair GB, Niederman MS. Updates on community acquired pneumonia management in the ICU. Pharmacology & therapeutics. 2021 Jan 1;217:107663.
  20. Caballero LA, Aijaz A, Paryani NS, Mahmood S, Salman M, Khan MO, Ahluwalia D, Siddiq MA, Hameed I. Comparing the efficacy of corticosteroids among patients with community- acquired pneumonia in the ICU versus non-ICU settings: A systematic review and meta-analysis. Steroids. 2024 Feb 13:109389.
  21. Williams DJ, Creech CB, Walter EB, Martin JM, Gerber JS, Newland JG, Howard L, Hofto ME, Staat MA, Oler RE, Tuyishimire B. Short-vs standard-course outpatient antibiotic therapy for community-acquired pneumonia in children: the SCOUT-CAP randomized clinical trial. JAMA pediatrics. 2022 Mar 1;176(3):253-61.
  22. Vaughn VM, Dickson RP, Horowitz JK, Flanders SA. Community-Acquired Pneumonia: A Review. Jama. 2024.
  23. Mukanhaire L, Li H, Fan Z, Yang L, Zheng Y, Ran Z, Zong X, Zhang L, Gong Y, Yang C, Gong JT. Efficacy of corticosteroids as an adjunctive therapy in the treatment of community- acquired pneumonia: a systematic review and meta-analysis. Acta Materia Medica. 2023 Jan 10;2(1):9-22
  24. Bielicki JA, Stöhr W, Barratt S, Dunn D, Naufal N, Roland D, Sturgeon K, Finn A, Rodriguez-Ruiz JP, Malhotra-Kumar S, Powell C. Effect of amoxicillin dose and treatment duration on the need for antibiotic re-treatment in children with community-acquired pneumonia: the CAP-IT randomized clinical trial. Jama. 2021 Nov 2;326(17):1713-24.
  25. Nakagawa Y, Kato H, Iwamoto T. Investigation of antimicrobial therapy for aspiration pneumonia in elderly nursing homes: a retrospective observational study in Japan. Pharmacy Practice. 2023 Sep 27;21(3):1-0.
  26. Martin-Loeches I, Garduno A, Povoa P, Nseir S. Choosing antibiotic therapy for severe community-acquired pneumonia. Current Opinion in Infectious Diseases. 2022 Apr 1;35(2):133- 9.
  27. Gao Y, Liu M, Yang K, Zhao Y, Tian J, Pernica JM, Guyatt G. Shorter versus longer-term antibiotic treatments for community-acquired pneumonia in children: a meta-analysis. Pediatrics. 2023 Jun 1;151(6):e2022060097.
  28. Bassetti M, Giacobbe DR, Magnasco L, Fantin A, Vena A, Castaldo N. Antibiotic Strategies for Severe Community-Acquired Pneumonia. InSeminars in Respiratory and Critical Care Medicine 2024 Feb 1. Thieme Medical Publishers, Inc..
  29. Uryasev OM, Shakhanov AV, Korshunova LV. Effectiveness of antimicrobial therapy for community-acquired pneumonia in real clinical practice. BULLETIN OF SIBERIAN MEDICINE. 2021 Dec 29;20(4):79-85.
  30. Scalera NM, File TM. Determining the duration of therapy for patients with community- acquired pneumonia. Current infectious disease reports. 2013 Apr;15:191-5.
  31. Bender MT, Niederman MS. Principles of antibiotic management of community-acquired pneumonia. InSeminars in Respiratory and Critical Care Medicine 2016 Dec (Vol. 37, No. 06, pp. 905-912). Thieme Medical Publishers.
  32. Niederman MS, Torres A. Severe community-acquired pneumonia. European Respiratory Review. 2022 Dec 31;31(166).
  33. Leung AK, Wong AH, Hon KL. Community-acquired pneumonia in children. Recent patents on inflammation & allergy drug discovery. 2018 Oct 1;12(2):136-44

Photo
M. Immanuel Jebastine
Corresponding author

Vels Institute of Science, Technologies & Advanced Studies, P.V Vaithiyalingam road, old Pallavaram, Chennai-600117, Tamilnadu, India.

Photo
S. Sathishkumar
Co-author

Vels Institute of Science, Technologies & Advanced Studies, P.V Vaithiyalingam road, old Pallavaram, Chennai-600117, Tamilnadu, India.

S. Sathishkumar, M. Immanuel Jebastine, Comparing the Efficacy of Different Antibiotic Regimens in Treating Community-Acquired Pneumonia: A Prospective Observational Study, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 3, 1141-1147. https://doi.org/10.5281/zenodo.15017447

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