New AHCPR Research Supports Use of Erythromycin for Pneumonia Outpatients

Media Advisory Date: Tuesday, July 1, 1997

Using the antibiotic erythromycin for treating community-acquired pneumonia (CAP) in most outpatients aged 60 and under significantly reduces treatment costs compared with the use of other antibiotics ($5.43 vs. $18.51), and has no adverse effect on medical outcomes. This finding is consistent with the guideline recommendation from the American Thoracic Society (ATS), which recommends erythromycin or other agents for those intolerant or allergic to this drug.

However, the ATS guideline does not recommend using erythromycin alone for CAP patients over 60 years of age, or patients of any age with an additional illness. Researchers at the University of Pittsburgh evaluating ATS guidelines found that using the recommended antibiotics for these patients (most often amoxicillin/clavulanate, sulfamethoxazole-trimethoprim, or cefuroxime) costs 10 times higher than using erythromycin or other non-recommended antibiotic ($73.50 vs. $7.50) and provides no increased effectiveness in medical outcomes.

This study, part of the Pneumonia Patient Outcomes Research Team (PORT) funded by the Agency for Health Care Policy and Research, is described in the July 2 issue of the Journal of the American Medical Association (JAMA). The PORT study provides the first objective data to compare the clinical effectiveness and costs of antibiotic therapy with clinical guidelines for community-acquired pneumonia.

About four-fifths of the four million Americans who develop pneumonia each year are treated as outpatients. Direct outpatient treatment costs exceed $1 billion per year, of which roughly $100 million is spent on antibiotic therapy. More than 30 oral antibiotic medications have been approved by the Food and Drug Administration for treatment of pneumonia, with costs ranging from $0.01 to more than $6 per dose. This has contributed to wide variations in prescribing patterns as well as increased antibiotic resistance.

The ATS guidelines were published in 1993 to improve the appropriateness of antibiotic prescribing practices for pneumonia patients treated in an outpatient setting. The AHCPR-supported researchers evaluated the guidelines by comparing medical outcomes and prescription costs among outpatients whose therapy was or was not consistent with ATS recommendations. They looked at a total of 864 adult patients: 546 aged 60 or younger with no comorbidity, and 318 older than 60 years of age or any age with at least one comorbidity.

The findings were reported by Patrick P. Gleason, Pharm.D. and Michael J. Fine, M.D., M.Sc. of the University of Pittsburgh's Center for Research on Health Care, and by co-investigators from the University of Pittsburgh, Harvard Medical School and Dalhousie University.

For additional information contact AHCPR Public Affairs: Karen Carp, (301) 427-1858 (KCarp@ahrq.gov) or Salina V. Prasad, (301) 427-1864 (SPrasad@ahrq.gov). The JAMA article is entitled "Medical Outcomes and Antimicrobial Costs With the Use of the American Thoracic Society Guidelines for Outpatients With Community-Acquired Pneumonia." To arrange interviews with Drs. Gleason and Fine, please contact Mark Kanny, University of Pittsburgh Medical Center News Bureau, (412) 647-3555 (kanny@a1.isd.upmc.edu).