Empirical therapy for nonhospitalized patients with community-acquired pneumonia. Study Group of General Practitioners.
A prospective survey involving a group of 95 general practitioners (GPs) in France was conducted to describe antibiotic therapy prescribed for out-patients with community-acquired pneumonia (CAP). A total of 173 cases of CAP, defined by the association of fever and pulmonary focal crackles and/or radiological changes consistent with a pulmonary infection, were reported between February 1993 and March 1994: 84 males and 89 females (mean age: 48 yrs) of whom 45% had no underlying disease. Nineteen (11%) were immediately hospitalized and the remaining 154 out-patients were treated without microbiological investigation. First-line antibiotic therapy was amoxicillin or amoxicillin-clavulanic acid combination (57%), a first or second generation cephalosporin (12%), ceftriaxone (8%), oral broad-spectrum cephalosporin (3%), a macrolide (16%), a tetracycline (1%) and a fluoroquinolone (2%). A total of 120 (78%) patients recovered with no change in treatment and 34 (22%) patients failed to improve: 18 were hospitalized and 16 had a second-line therapy, mainly a macrolide or a quinolone. Five patients died at hospital. The overall mortality was 3%, and 14% in hospitalized patients. Empirical therapy using a betalactam to target a presumed pneumococcal infection, in agreement with European guidelines, is appropriate for out-patients with mild lobar community-acquired pneumonia.
Laurichesse
H
H
Infectious disease ward, Hôtel-Dieu, University Hospital of Clermont-Ferrand, France.
Robin
F
F
Gerbaud
L
L
Pochet
P
P
Gourdon
F
F
Beytout
J
J
Rey
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011014:Pneumonia / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents