{"doi":"10.1093/cid/ciae519","title":"Comparative Safety of Different Antibiotic Regimens for the Treatment of Outpatient Community-Acquired Pneumonia Among Otherwise Healthy Adults","abstract":"BACKGROUND: Evidence is limited on the comparative safety of antibiotic regimens for treatment of community-acquired pneumonia (CAP). We compared the risk of adverse drug events (ADEs) associated with antibiotic regimens for CAP treatment among otherwise healthy, nonelderly adults. METHODS: We conducted an active-comparator new-user cohort study (2007-2019) of commercially insured adults aged 18-64 years diagnosed with outpatient CAP, evaluated via chest X-ray, and dispensed a same-day CAP-related oral antibiotic regimen. ADE follow-up duration ranged from 2 to 90 days (eg, renal failure [14 days]). We estimated risk differences [RDs] per 1000 treatment episodes and risk ratios using propensity score-weighted Kaplan-Meier functions. Ankle/knee sprain and influenza vaccination were considered as negative control outcomes. RESULTS: Of 145 137 otherwise healthy CAP patients without comorbidities, 52% received narrow-spectrum regimens (44% macrolide, 8% doxycycline) and 48% received broad-spectrum regimens (39% fluoroquinolone, 7% β-lactam, 3% β-lactam + macrolide). Compared with macrolide monotherapy, each broad-spectrum antibiotic regimen was associated with increased risk of several ADEs (eg, β-lactam: nausea/vomiting/abdominal pain [RD per 1000, 3.20; 95% CI, 0.99-5.73]; non-Clostridioides difficile diarrhea [RD per 1000, 4.61; 95% CI, 2.47-6.82]; vulvovaginal candidiasis/vaginitis [RD per 1000, 3.57; 95% CI, 0.87, 6.88]). Narrow-spectrum antibiotic regimens largely conferred similar risk of ADEs. We generally observed similar risks of each negative control outcome, indicating minimal confounding. CONCLUSIONS: Broad-spectrum antibiotics were associated with increased risk of ADEs among otherwise healthy adults treated for CAP in the outpatient setting. Antimicrobial stewardship is needed to promote judicious use of broad-spectrum antibiotics and ultimately decrease antibiotic-related ADEs.","journal":"Clinical Infectious Diseases","year":2024,"id":477803,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8711,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":489803,"name":"Katelin B. Nickel","orcid":"0000-0003-4116-512X","position":1,"is_corresponding":false},{"id":385409,"name":"Margaret A. Olsen","orcid":"0000-0001-7070-9320","position":2,"is_corresponding":false},{"id":388574,"name":"John M. Sahrmann","orcid":"0000-0001-6000-0908","position":3,"is_corresponding":false},{"id":426221,"name":"Ryan Colvin","orcid":"0009-0004-3698-7457","position":4,"is_corresponding":false},{"id":802631,"name":"Elizabeth Neuner","orcid":"0000-0002-5534-1748","position":5,"is_corresponding":false},{"id":388577,"name":"Caroline A. O’Neil","orcid":"0000-0003-2966-0750","position":6,"is_corresponding":false},{"id":788160,"name":"Victoria J. Fraser","orcid":"0000-0001-6251-0733","position":7,"is_corresponding":false},{"id":316349,"name":"Michael J. Durkin","orcid":"0000-0003-4652-7089","position":8,"is_corresponding":false},{"id":388579,"name":"Anne M. Butler","orcid":"0000-0001-7307-6864","position":0,"is_corresponding":true}],"reference_count":33,"raw_metadata":null,"created_at":"2026-07-19T02:06:37.812633Z","pmid":"39442057","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}