Abstract
Community-acquired pneumonia (CAP) is a common and potentially serious illness that is associated with morbidity and mortality. Although medical care has improved during the past decades, it is still potentially lethal. Streptococcus pneumoniae is the most frequent microorganism isolated. Treatment includes mandatory antibiotic therapy and organ support as needed. There are several antibiotic therapy regimens that include β-lactams or macrolides or fluoroquinolones alone or in combination. Combination antibiotic therapy achieves a better outcome compared with monotherapy and it should be given in the following subset of patients with CAP: outpatients with comorbidities and previous antibiotic therapy, nursing home patients with CAP, hospitalized patients with severe CAP, bacteremic pneumococcal CAP, presence of shock, and necessity of mechanical ventilation. Better outcome is associated with combination therapy that includes a macrolide for wide coverage of atypical pneumonia, polymicrobial pneumonia, or resistant Streptococcus pneumoniae. Macrolides have shown different properties other than antimicrobial activity, such as anti-inflammatory properties. Although this evidence comes from observational, most of them retrospective and nonblinded studies, the findings are consistent. Ideally, a prospective, multicenter, randomized trial should be performed to confirm these findings.
Highlights
Community-acquired pneumonia (CAP) is a common and potentially serious illness that is associated with morbidity and mortality [1]
In the nursing home without hospitalization, a respiratory fluoroquinolone or amoxicillin-clavulanate plus a macrolide is recommended as the first-choice [10]
CAP and shock An observational study of patients with pneumonia who require intensive care unit (ICU) care found that patients with CAP and shock who were treated with combination antibiotic therapy (58% with a third-generation cephalosporin plus a macrolide), compared with those treated with monotherapy (42% fluoroquinolone), had a higher 28-day inICU survival (HR, 2.69; 95% CI, 1.09-2.6)
Summary
Community-acquired pneumonia (CAP) is a common and potentially serious illness that is associated with morbidity and mortality [1]. CAP that requires hospitalization Two frequent recommended antibiotic regimens for hospitalized patients with CAP are an extended-spectrum b-lactam (an extended-spectrum cephalosporin or b-lactam-b-lactamase inhibitor) with a macrolide or an antipneumococcal quinolone These regimens have activity against the major causes of CAP, including drug-resistant Streptococcus pneumoniae [12,13,14,15]. There were no statistical differences between patients who did or did not receive a macrolide in terms of comorbid illnesses, length of hospital stay (5.2 ± 2.8 vs 5.2 ± 3.4 days, respectively), length of intravenous antibiotic therapy (4.4 ± 2.5 vs 4.1 ± 2.3 days, respectively), or mortality (0.9% vs 3.1%, respectively; p = 0.333) This low mortality shows that those patients did not have severe CAP. Metersky et al [26] 2007 Pneumococcal bacteremia Ward Lower 30-day mortality with b-lactam plus macrolide
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