Empiric penicillin monotherapy of CAP is not associated with increased mortality; experiences from the retrospective CAP-North cohort

Background: Community-acquired pneumonia (CAP) is a severe infection, with high morbidity and mortality. The antibiotic strategies for CAP differ across Europe. Objective: To assess the usage of Penicillin monotherapy in a real-life cohort and to evaluate predictors of treatment duration and the prognosis of patients with CAP. Methods: Adult patients with CAP, verified by an infiltrate on chest X-ray, hospitalized in three Danish hospitals during January 2011 to July 2012 were identified. We calculated the population-based incidence, reviewed types and duration of antibiotic treatment, and evaluated predictors of treatment duration by linear regression. Mortality of patients receiving empiric penicillin-G/V was compared to others by logistic regression analysis. The CAPNETZ database technology was used for data-capture. Results: We included 1320 patients. The incidence of hospitalized CAP was 3.1 per 1000 inhabitants. The median age was 71 years (IQR; 58.81). In-hospital mortality was 8%. Patients treated with penicillin-G/V as empiric monotherapy (45%) did not have a higher mortality than those treated with broader spectrum antibiotics (OR 1.30, CI 95% 0.84-2-02). The median duration of antibiotic treatment was 10 days (IQR; 8-12). Longer treatment was associated with a more severe course of CAP, including complications, high CRP day 3 and detection of a pathogen. Conclusion: Empiric therapy with penicillin was commonly used and not associated with increased mortality in patients with mild to moderate pneumonia. The duration of treatment was longer than recommended in European guidelines and associated to severity.