Does radiographic evidence of prior pulmonary tubercular infection influence the choice of empiric antibiotics for community-acquired pneumonia in a tuberculosis-endemic area?

Abstract

Background/purpose: Recent medical literature suggests that use of fluoroquinolones (FQs) might be associated with the delayed diagnosis of pulmonary tuberculosis (TB). The purpose of this study was to assess the impact of radiographic evidence of prior pulmonary TB infection on empiric antibiotic choice in cases of community-acquired pneumonia (CAP), as well as the effect of antibiotic regimens on clinical outcome.

Methods: A total of 280 patients with CAP between 1 May and 31 December 2007 were included in the study and their medical records were retrospectively reviewed. Patients were divided into two groups: those receiving FQs (FQ group) or those receiving β-lactam-based regimens (β-lactam group). Their demographic data, underlying diseases, clinical features, diseases severity and outcomes were compared.

Results: Radiographic evidence of a previous pulmonary TB infection (odds ratio = 3.507, 95% confidence interval = 1.422-8.645; p = 0.006) was an independent factor associated with β-lactam-based regimens. Patients with a modified pneumonia severity index (mPSI) category V were more likely to receive FQ therapy (odds ratio = 2.53, 95% confidence interval = 1.140-5.615; p = 0.022). Of the patients with mPSI category V, the 14-day mortality rate of those in the β-lactam group was significantly lower than that of those in the FQ group (0%vs. 23%, respectively; p = 0.044).

Conclusion: Radiographic evidence of a previous pulmonary TB infection and a lower mPSI score increases the probability of the selection of a β-lactam-based regimen for the treatment of CAP.