2197. Ceftriaxone Monotherapy vs. Ceftriaxone Plus Azithromycin for the Treatment of Community-Acquired Pneumonia in Hospitalized, Non-ICU Patients

BACKGROUND: Community-acquired pneumonia (CAP) is the leading infectious cause of death and severe sepsis in the United States and the fifth leading cause of death overall worldwide. Current United States guidelines for the treatment of CAP recommend empiric antibiotic therapy that covers both standard organisms as well as atypical organisms. Ceftriaxone (CTX) in combination with azithromycin (AZH) is one of the most common regimens used for the treatment of CAP; however, there are studies that show β-lactam monotherapy is as effective as a β-lactam in combination with AZH for the empiric treatment of CAP. The purpose of this study was to compare the rates of treatment failure between CTX monotherapy and CTX in combination with AZH in non-intensive care unit (ICU) inpatients. METHODS: Non-ICU hospitalized patients ≥ 18 years old admitted to Saint Vincent Healthcare with a primary or secondary ICD-10 code of pneumonia from 2013 to 2018 were included. Patients were excluded if they were pregnant, admitted within 2 weeks of a previous episode of CAP, were admitted to the ICU, had cystic fibrosis, or were given antibiotics with atypical coverage (other than azithromycin) prior to admit or within 24 hours of presentation. The primary outcome was treatment failure defined as a composite of any of the following: (1) attributable mortality, (2) in vitro resistance, and (3) change of antibiotic class. Secondary outcomes included length of stay, antibiotic duration, time to oral antibiotics, and readmission within 30 days. RESULTS: There were 84 and 159 patients included in the CTX and CTX+AZH groups, respectively. Baseline demographics between groups are shown in Table 1. The composite primary endpoint occurred in 22 patients (26.2%) in the CTX group and in 48 patients (30.2%) in the CTX + AZH group. After adjusting for gender, race, in hospital death, chronic obstructive pulmonary disease, length of therapy, length of stay, and systemic inflammatory response syndrome, CTX monotherapy was no less effective than CTX+AZH (aOR 0.55; 95% CI: 0.27 to 1.1; P = 0.09). The primary endpoint and secondary endpoints are shown in Tables 2 and 3, respectively. CONCLUSION: There was no difference between CTX monotherapy and CTX + AZH for the empiric treatment of CAP. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.