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Frédéric Lavoie
Lucie Blais
Anne-Marie Castilloux
Alissa Scalera
Jacques LeLorier


Treatment effectiveness, cost effectiveness, lower respiratory tract infection, azithromycin



The antibacterial activity, tolerability profile and duration of treatment associated with antibiotics are important therapy attributes when considering treating patients for lower respiratory tract infections (LRTIs), such as community acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB).


To investigate the effectiveness and cost-effectiveness of oral antibiotics used in the treatment of LRTIs.


A cohort of inhaled corticosteroids users who were diagnosed with a LRTI and dispensed a prescription for  one  of  the  antibiotics  under  study  on  the  same  day  as  the  diagnosis  was  selected  from  the administrative health databases of the Régie de l'assurance maladie du Québec (RAMQ). The risks of treatment failure were estimated using a logistic regression analysis. Treatment failure was defined as another prescription for any antibiotic, an emergency room visit or hospitalization for LRTIs, or death, in the 20 days following the dispensation of the first antibiotic prescribed. A cost-minimization analysis was performed in which only the drug costs related to the first antibiotic filled were considered.


A  total  of  3,610 episodes of  LRTIs were studied.   There were no  significant differences between antibiotics in terms of their respective adjusted odds ratios for rates of failure. However, the lower cost associated  with  azithromycin  was  significantly  different  from  the  costs  associated  with  any  other antibiotic (p<0.0001).


Clinical effectiveness appears to be similar amongst second line antibiotics that are commonly used in the treatment of LRTIs in the community. Using a cost-minimization analysis, azithromycin appears to be the most cost-effective antibiotic treatment in this setting.

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