Drug Fights Community-Acquired Pneumonia
By Joan Unger RN, MS, ARNP-C
Docycycline is highly effective and often prescribed for outpatient treatment of common lower respiratory tract infection. The objective of this randomized prospective trial was to evaluate the effect of intravenous (IV) doxycycline with other antibiotic regimens used empirically to treat inpatients with mild to moderate community-acquired pneumonia.
Half of the 87 study subjects (43) were randomly assigned to receive 100 mg of IV doxycycline every 12 hours. The control group (43) received other antibiotics. Clinical and laboratory findings were similar in the two groups. The mean interval between initiating an antibiotic and clinical response was 2.21+/-2.61 days in the doxycycline group and 3/84+/-6.39 in the control group. Mean length of hospitalization for the study group was 4.14+/-3.08 days, compared with 6.14+/-6.65 in the control group. More rapid response and decrease length of hospital stay resulted in significant hospitalization costs: $5,126 for the study group and $6,528 for the controls. In addition, the median cost of the antibiotic therapy for the study group ($33) was considerably lower than that of the control group ($170.90).
Researchers concluded that doxycycline is effective and less costly empirical therapy for hospitalized patients with mild to moderate community-acquired pneumonia.
Ailani R. Doxycycline is a cost-effective therapy for hospitalized patients with community-acquired pneumonia. Arch Intern Med 1999;159:266-70.
Pain Predicts Risk for Adverse Angina Outcomes
This study compares the outcomes of more than 1,000 patients with and without unstable angina pain following atherectomy or angioplasty to determine if the patient’s clinical presentation may provide a clue to those at high risk for poor outcomes after percutaneous revascularization. Patients were classified by clinical presentation, including those having chest pain at rest, after myocardial infarction (MI), accompanying ischemic electrocardiographic (ECG) changes, and having no chest pain. Only subjects whose chest pain accompanied electrocardiographic changes had significantly predictive outcomes. The rate of mortality, MI, bypass surgery, abrupt vessel closure, and/or repeated atherectomy or angioplasty was 24% in unstable angina patients with chest pain and ECG changes. The rate in patients with unstable angina without chest pain was 17%. Chest pain at rest was predictive of the composite outcome. Outcomes for patients with unstable angina, regardless of the subgroup, were worse after atherectomy and after angioplasty.
Researchers concluded that chest pain at rest and chest pain with ECG changes may indicate patients at risk for adverse outcomes after percutaneous coronary intervention and propose that other therapeutic measures be tried. Authors point out that larger studies are necessary to determine which interventions are most effective for these high-risk patients. (See patient handout on managing unstable angina enclosed in this issue.)
Harrington, R. Is all unstable angina the same? Insights from the Coronary Angioplasty Versus Excisional Atherec tomy Trial (CAVEAT-1) Am Heart J 1999;137: 227-233.