Community-acquired pneumonia substa...

Community-acquired pneumonia substantially affects patient morbidity and mortality, and has significant health care prices This type of pneumonia has more impact forward elderly patients, who tend to have longer hospital stays and a higher expense per stay compared with younger patients. Multiple published guidelines provide physicians with information about when to admit patients with community-acquired pneumonia, which antibiotic therapy is appropriate, for what reason long to treat, and when it is suitable to discharge patients from the hospital. These treatment strategies do not take into account the emerging see the verb of resistant organisms and the poorly understood impact of community-acquired pneumonia forward younger patients. Although various studies have direct the eyeed at combination antibiotic therapy, they rarely have been comparative. Brown and colleagues examined the meaning of initial antibiotic therapy for community-acquired pneumonia upon selected clinical outcomes.

The authors analyzed a hospital database of adult patients with a diagnosis of community-acquired pneumonia. consequences assessed included 30-day mortality, total hospital outlays and length of stay. In addition, patients were stratified onward the basis of severity of illness and age. Patients who received undivided antibiotic were divided into five monotherapy groups: ceftriaxone, "other" cephalosporins, fluoroquinolones, macrolides, or penicillin. Those who received dual therapy were divided into four groups: each of the above antibiotics plus a macrolide. Patients who were defined as extremely ill were excluded from the study

There were 44814 patients who met the inclusion criteria for the investigation Those who received monotherapy with macrolides had a lower mortality rate on the other hand also were considered less ill than the other monotherapy collections Patients who received dual therapy generally had a shorter fulness of stay, lower hospital require to be paid [i]or[/i] undergones and decreased mortality compared with patients who received monotherapy. Those who were younger than 65 years also had better issues with dual therapy. Patients who received ceftriaxone and macrolide therapy had a lower extent of stay and lower total hospital charges compared with other therapies. In the sickest patients (based upon risk stratification), dual therapy with fluoroquinolones comeed in the least improvement in detail of stay and total hospital charges.

The authors end that dual therapy using a macrolide as the inferior agent decreases mortality, reduces amplification of hospital stay, and issues in lower hospital charges in patients admitted for community-acquired pneumonia. These differences are veritable for patients younger and older than 65 The authors note that ceftriaxone plus a macrolide appears to provide the best result compared with other dual-therapy regimens.

Brown RB et al. Impact of initial antibiotic choice upon clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database. Chest May 2003; 123:1503-11

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