Severe pneumonia and a second antibiotic

Abstract

Streptococcus pneumoniae is the most common cause of community acquired pneumonia (CAP) and the pathogen causing most deaths. CAP management guidelines in North America and the UK recommended that patients with severe pneumonia be given initially a combination antibiotic therapy. According to a recent retrospective study adults with severe bacteremic pneumococcal pneumonia have significantly greater risk of death if they receive a single antibiotics rather than combination antibiotics on the first day of admission. Although some patients died shortly after admission half of the deaths occurred after 5 days and mortality rates continued to increase throughout the 15-day study suggesting that subsequent antibiotic therapy might be an important determinant of outcome. Hence the investigators recommended a double-blind trial of single versus combination therapy for patients with severe CAP and suspected bacteremic pneumococcal pneumonia. The need to cover this pathogen effectively in any empirical antibiotic regimen for CAP remains a priority.