Aspiration pneumonia outcomes better with ampicillin–sulbactam vs cephalosporins

In the treatment of patients with aspiration pneumonia, ampicillin–sulbactam helps reduce in-hospital mortality and prevent Clostridioides difficile infection compared with cephalosporins, according to a study from Japan.

Researchers used the Diagnosis Procedure Combination (DPC) database and identified patients who received a diagnosis of aspiration pneumonia and subsequently treated with ampicillin-sulbactam or third-generation cephalosporins (ceftriaxone or cefotaxime).

Outcomes such as in-hospital mortality and the incidence of C. difficile infection were compared between the two treatment groups using propensity score overlap weighting analysis.

A total of 548,972 patients were included in the analysis, with 424,446 receiving ampicillin-sulbactam. Of the 124,526 patients treated with third-generation cephalosporins, 97.7 percent received ceftriaxone and 2.3 percent received cefotaxime. The mean treatment duration was 8.5 days in the ampicillin-sulbactam group and 7.9 days in the third-generation cephalosporin group.

Compared with patients who received third-generation cephalosporins, ampicillin–sulbactam-treated patients had significantly lower in-hospital mortality (14.6 percent vs 16.4 percent; risk difference [RD], −1.8 percent, 95 percent confidence interval [CI], −2.1 to −1.5; p<0.001).

Furthermore, significantly fewer ampicillin–sulbactam-treated patients contracted C. difficile infection compared with those who received third-generation cephalosporins (2.0 percent vs 2.8 percent; RD, −0.8 percent, 95 percent CI, −0.9 to −0.7; p<0.001).

The findings demonstrate that ampicillin-sulbactam is associated with better treatment outcomes compared with third-generation cephalosporins for patients with aspiration pneumonia.