Evidence map›Paper›PMID 38663754›Full record

ArticleThe Journal of infection2024

No evidence of difference in mortality with amoxicillin versus co-amoxiclav for hospital treatment of community-acquired pneumonia.

Jia Wei, Aashna Uppal, Christy Nganjimi, Hermione Warr, Yasin Ibrahim, Qingze Gu, Hang Yuan, Najib M Rahman, Nicola Jones, A Sarah Walker and 1 more

Erratum issuedOpen access · goldAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of infection, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.9field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 5 citations in OpenAlex.

  1. Pooled it
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  3. Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 5 institutions in 1 country.

Jia WeiNuffield Department of Medicine, University of Oxford, Oxford, UK.
Aashna UppalNuffield Department of Medicine, University of Oxford, Oxford, UK.
Christy NganjimiDepartment of Engineering Science, University of Oxford, Oxford, UK.
Hermione WarrDepartment of Engineering Science, University of Oxford, Oxford, UK.
Yasin IbrahimDepartment of Engineering Science, University of Oxford, Oxford, UK.
Qingze GuNuffield Department of Medicine, University of Oxford, Oxford, UK.
Hang YuanBig Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Najib M RahmanNuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK; The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
Nicola JonesDepartment of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
A Sarah WalkerNuffield Department of Medicine, University of Oxford, Oxford, UK; The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK.
David W EyreBig Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK; The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK; The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK. Electronic address: david.eyre@bdi.ox.ac.uk.
University of Oxford · GBJohn Radcliffe Hospital · GBChurchill Hospital · GBNational Institute for Health Research · GBOpen Data Institute · GB

Funding

Wellcome Trust
6 · The paper itself

Abstract

objectivesCurrent guidelines recommend broad-spectrum antibiotics for high-severity community-acquired pneumonia (CAP), potentially contributing to antimicrobial resistance (AMR). We aim to compare outcomes in CAP patients treated with amoxicillin (narrow-spectrum) versus co-amoxiclav (broad-spectrum), to understand if narrow-spectrum antibiotics could be used more widely.

methodsWe analysed electronic health records from adults (≥16 y) admitted to hospital with a primary diagnosis of pneumonia between 01-January-2016 and 30-September-2023 in Oxfordshire, United Kingdom. Patients receiving baseline ([-12 h,+24 h] from admission) amoxicillin or co-amoxiclav were included. The association between 30-day all-cause mortality and baseline antibiotic was examined using propensity score (PS) matching and inverse probability treatment weighting (IPTW) to address confounding by baseline characteristics and disease severity. Subgroup analyses by disease severity and sensitivity analyses with missing covariates imputed were also conducted.

resultsAmong 16,072 admissions with a primary diagnosis of pneumonia, 9685 received either baseline amoxicillin or co-amoxiclav. There was no evidence of a difference in 30-day mortality between patients receiving initial co-amoxiclav vs. amoxicillin (PS matching: marginal odds ratio 0.97 [0.76-1.27], p = 0.61; IPTW: 1.02 [0.78-1.33], p = 0.87). Results remained similar across stratified analyses of mild, moderate, and severe pneumonia. Results were also similar with missing data imputed. There was also no evidence of an association between 30-day mortality and use of additional macrolides or additional doxycycline.

conclusionsThere was no evidence of co-amoxiclav being advantageous over amoxicillin for treatment of CAP in 30-day mortality at a population-level, regardless of disease severity. Wider use of narrow-spectrum empirical treatment of moderate/severe CAP should be considered to curb potential for AMR.

Indexed as

AmoxicillinAmoxicillin-Potassium Clavulanate CombinationAnti-Bacterial AgentsCommunity-Acquired InfectionsAdultAgedAged, 80 and overFemaleHospitalizationHumansMaleMiddle AgedPneumoniaPneumonia, BacterialRetrospective StudiesTreatment OutcomeAmoxicillinAmoxicillin-Potassium Clavulanate CombinationAnti-Bacterial Agents30-day mortalityAmoxicillinAntimicrobial resistanceCo-amoxiclavCommunity-acquired pneumonia

Identifiers

PMID38663754
PMCPMC11893475
OpenAlexW4395053189

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.