{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T13:44:19Z","timestamp":1789825459641,"version":"4.0.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T00:00:00Z","timestamp":1729641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Centers for Disease Control and Prevention, Prevention Epicenters","award":["U54CK000609"],"award-info":[{"award-number":["U54CK000609"]}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"(NCATS)","doi-asserted-by":"crossref","award":["KL2TR002346"],"award-info":[{"award-number":["KL2TR002346"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Washington University Institute of Clinical and Translational Sciences","award":["UL1 TR002345"],"award-info":[{"award-number":["UL1 TR002345"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R24 HS19455"],"award-info":[{"award-number":["R24 HS19455"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence is limited on the comparative safety of antibiotic regimens for treatment of community-acquired pneumonia (CAP). We compared the risk of adverse drug events (ADEs) associated with antibiotic regimens for CAP treatment among otherwise healthy, nonelderly adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an active-comparator new-user cohort study (2007\u20132019) of commercially insured adults aged 18\u201364 years diagnosed with outpatient CAP, evaluated via chest X-ray, and dispensed a same-day CAP-related oral antibiotic regimen. ADE follow-up duration ranged from 2 to 90 days (eg, renal failure [14 days]). We estimated risk differences [RDs] per 1000 treatment episodes and risk ratios using propensity score\u2013weighted Kaplan-Meier functions. Ankle\/knee sprain and influenza vaccination were considered as negative control outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 145 137 otherwise healthy CAP patients without comorbidities, 52% received narrow-spectrum regimens (44% macrolide, 8% doxycycline) and 48% received broad-spectrum regimens (39% fluoroquinolone, 7% \u03b2-lactam, 3% \u03b2-lactam + macrolide). Compared with macrolide monotherapy, each broad-spectrum antibiotic regimen was associated with increased risk of several ADEs (eg, \u03b2-lactam: nausea\/vomiting\/abdominal pain [RD per 1000, 3.20; 95% CI, 0.99\u20135.73]; non\u2013Clostridioides difficile diarrhea [RD per 1000, 4.61; 95% CI, 2.47\u20136.82]; vulvovaginal candidiasis\/vaginitis [RD per 1000, 3.57; 95% CI, 0.87, 6.88]). Narrow-spectrum antibiotic regimens largely conferred similar risk of ADEs. We generally observed similar risks of each negative control outcome, indicating minimal confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Broad-spectrum antibiotics were associated with increased risk of ADEs among otherwise healthy adults treated for CAP in the outpatient setting. Antimicrobial stewardship is needed to promote judicious use of broad-spectrum antibiotics and ultimately decrease antibiotic-related ADEs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciae519","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T15:26:42Z","timestamp":1729524402000},"page":"1141-1151","source":"Crossref","is-referenced-by-count":4,"title":["Comparative Safety of Different Antibiotic Regimens for the Treatment of Outpatient Community-Acquired Pneumonia Among Otherwise Healthy Adults"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7307-6864","authenticated-orcid":false,"given":"Anne M","family":"Butler","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St. Louis, Missouri ,","place":["USA"]},{"name":"Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4116-512X","authenticated-orcid":false,"given":"Katelin B","family":"Nickel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7070-9320","authenticated-orcid":false,"given":"Margaret A","family":"Olsen","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6000-0908","authenticated-orcid":false,"given":"John M","family":"Sahrmann","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3698-7457","authenticated-orcid":false,"given":"Ryan","family":"Colvin","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Neuner","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Barnes-Jewish Hospital , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2966-0750","authenticated-orcid":false,"given":"Caroline A","family":"O\u2019Neil","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6251-0733","authenticated-orcid":false,"given":"Victoria J","family":"Fraser","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Durkin","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,10,23]]},"reference":[{"key":"2026020907374942000_ciae519-B1","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1001\/jama.2016.4151","article-title":"Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010\u20132011","volume":"315","author":"Fleming-Dutra","year":"2016","journal-title":"JAMA"},{"key":"2026020907374942000_ciae519-B2","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1086\/511159","article-title":"Infectious Diseases Society of America\/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults","volume":"44(Suppl 2)","author":"Mandell","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2026020907374942000_ciae519-B3","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia. 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