Time to revisit empiric atypical coverage in non-severe CAP? 🆕⚡🔴Target trial emulation using a propensity-weighted cohort from 68 hospitals in Michigan >66,000 patients: • No difference in time to clinical stability • No difference in ICU transfer or antibiotic duration • No difference in 30-day mortality • But ↓ composite 30-day mortality/rehospitalization with azithromycin Signal… or bias?” academic.oup.com/cid/article-ab…

@ABsteward @DrToddLee I wish people would stop with this “target trial emulation” business. You did a retrospective observational study with propensity matching. Period. Be honest & call it that. Result won’t affect my practice. If atypical pna possible give azithro. If it’s a typical pathogen, don’t.

@BradSpellberg @ABsteward @DrToddLee Has there ever been a randomized placebo controlled (with no antibiotic in the control group) trial for outpatient pneumonia treatment in a developed country?

@austingmeyer @ABsteward @DrToddLee Apologies I gave you the link to the wrong article before. Please disregard the 2010 position paper. I was doing it on my phone. The 2008 workshop summary is the correct paper here (refs 16-20): pmc.ncbi.nlm.nih.gov/articles/PMC28…

Thanks. Are there any for typical pneumonia also? I believe all of those were atypicals. I'm just having trouble finding any for typical CAP in the outpatient setting (where there likely wouldn't be microbiologic confirmation). I'm mostly wondering because most of these radiographic pneumonias are viruses or atypicals.

@austingmeyer @BradSpellberg @ABsteward @DrToddLee I think there is good data showing that using low crp in a POCT as a reason to withhold antibiotics is safe. Some of those with low crp may have bacterial pneumonia, but it doesn’t seem to matter.