Should third-generation cephalosporins be the empirical treatment of choice for severe community-acquired pneumonia in adults?
The choice of empirical treatment for community-acquired pneumonia (CAP) is highly controversial. Our survey of 42 Australian emergency department doctors showed that monotherapy with a third-generation cephalosporin was the preferred regimen for severe CAP (14/42; 33%). We argue that cheaper regimens with a narrower spectrum are likely to be just as effective as third-generation cephalosporins and will have fewer adverse effects on the microbial ecology of hospitals. We suggest penicillin or ampicillin (to cover pneumococci--even if penicillin "resistant"--and Haemophilus influenzae), plus a macrolide (e.g., azithromycin or erythromycin; to cover Legionella and other "atypical" pathogens), plus a single large dose of an aminoglycoside (e.g., gentamicin; to cover gram-negative bacilli such as Klebsiella pneumoniae) as empirical therapy for severe CAP.
Paterson
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DL
Infectious Disease Section, Veterans Affairs Medical Center, Pittsburgh, PA 15240, USA. paterson@med.pitt.edu
Playford
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EG
D000328:Adult; D001315:Australia; D002511:Cephalosporins / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004363:Drug Utilization; D004638:Emergency Treatment; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D011014:Pneumonia / Q000188:drug therapy* / Q000382:microbiology; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index
D002511:Cephalosporins