The changing landscape in CABP
presents real concerns for patients

Patients at risk

Patients at risk for negative outcomes

  • Common comorbidities, such as diabetes and COPD, are significant predictors for negative outcomes, including hospitalizations, in patients with pneumonia1-3
  • Prior antibiotic use increases the likelihood of antibiotic resistance4
    • Several studies have shown that the duration of antibiotic therapy often greatly exceeds US standards of practice as well as the recommendations of the current guidelines5
Safety Concerns

Safety concerns with common antibiotics

  • Fluoroquinolones have boxed warnings due to their numerous adverse side effects, including tendon rupture, mental health issues, aortic dissections, and hypoglycemia that can lead to coma6-8
  • Other common classes of antibiotics, such as macrolides and cephalosporins, may also lead to serious safety concerns9,10
The threat of hospitalization

The threat of hospitalization

  • Hospitalization can increase risk of complications in patients with CABP/pneumonia, including risk of thromboembolic events and “superinfection” by resistant hospital bacteria4
  • Severity of pneumonia is often overestimated, resulting in a significant number of patients being hospitalized unnecessarily4
  • The cost of antibiotic resistance to the US economy could be massive due to extended hospital stays, follow-up visits, and the need to treat potential toxicity11
Rising Resistance

Rising resistance

  • By 2050, it is estimated that up to 10 million worldwide deaths could occur annually due to antibiotic resistance12
  • Antibiotic resistance has continued to increase13
  • ATS/IDSA guidelines have recently changed13
  • If S. pneumoniae resistance is greater than 25% in a particular geographic area, the latest guidelines do not recommend macrolide monotherapy use13

See below for S. pneumoniae resistance rates to azithromycin, penicillin, and tetracycline

The CDC has deemed drug-resistant S. pneumoniae a particularly concerning public health threat11,14

Resistance patterns can vary by geography, as seen in this example15

Drug-resistant pathogens will undermine the ability to fight infectious diseases—such as pneumonia—as antibiotics become less effective.11 In the absence of culture and susceptibility data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.16

Distribution of azithromycin, penicillin, and tetracycline resistance for S. pneumoniae15,*
Azithromycin
Resistance
Penicillin
Resistance
Tetracycline
Resistance
Pacific 28.8% 26.8% 12.8%
Mountain 23.8% 29.3% 17.5%
West North Central 52.4% 36.1% 18.0%
West South Central 59.1% 56.3% 23.8%
East North Central 44.2% 35.5% 17.4%
East South Central 52.2% 42.2% 28.2%
Mid-Atlantic 40.2% 36.9% 21.4%
South Atlantic 47.0% 42.4% 17.1%
New England 44.7% 28.8% 28.0%

Data presented are from 2010 to 2019 (tetracycline data are from 2015-2019). Dataset provided by JMI Labs and the SENTRY Antimicrobial Surveillance Program, available at sentry-mvp.jmilabs.com. Accessed December 3, 2019. Resistance percentages also include the indeterminate category.

In vitro data are based on Clinical and Laboratory Standards Institute (CLSI) 2019 susceptibility breakpoints. Streptococcus pneumoniae isolates are from bloodstream and community-acquired respiratory tract infections.15

CLSI breakpoint (penicillin = oral, non-meningitis)

New antibiotics are valuable to effective antibiotic stewardship

For nearly 20 years, there has been no novel class approved for the treatment of CABP—yet new antibiotics are valuable for effective antibiotic stewardship17-19

IDSA/SHEA antibiotic stewardship guidelines for antibiotic use and sustainability include but are not limited to17,20:

Transitioning early from IV to oral

Transitioning early
from IV to oral

administration to help shorten length of stay

shortest effective duration

Using antibiotic therapy for the

shortest
effective duration

new antibiotic classes

Developing systemic drugs in

new antibiotic classes

to address resistance

ATS=American Thoracic Society; CAP=community-acquired pneumonia; CABP is a designation by the FDA to refer specifically to CAP patients with bacterial pneumonia; COPD=chronic obstructive pulmonary disease; IDSA=Infectious Diseases Society of America.