An appraisal of treatment guidelines for antepartum community-acquired pneumonia.
OBJECTIVE
The optimal strategy for the initial evaluation and management, including criteria for hospitalization, of pregnant women with pneumonia has not been defined. Our purpose was to evaluate a treatment protocol for antepartum pneumonia and to identify criteria for selection of women for potential outpatient treatment.


METHODS
A protocol based on British and American Thoracic Society guidelines was introduced and included prompt hospitalization and empiric initiation of erythromycin therapy. Maternal and neonatal outcomes were analyzed to assess the efficacy of the protocol. A second analysis involved the retrospective application of published guidelines to ascertain for which women outpatient management might have been appropriate.


RESULTS
There were no maternal deaths among the 133 women studied, and in 14 (10%) women there was a misdiagnosis at admission. Erythromycin monotherapy was judged adequate in all but one of the 99 women so treated. Using a modified version of the American Thoracic Society guidelines, we project that only 25% of the women hospitalized with pneumonia could have been managed safely as outpatients.


CONCLUSIONS
Most pregnant women with pneumonia respond well to monotherapy with erythromycin. Outpatient management may be a reasonable option for selected women.
Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas 75235-9032, USA.
N P
NP
Yost
S L
SL
Bloom
S D
SD
Richey
S M
SM
Ramin
F G
FG
Cunningham
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004917:Erythromycin / Q000627:therapeutic use; D005260:Female; D006192:Haemophilus Infections / Q000635:transmission; D006193:Haemophilus influenzae; D006291:Health Policy; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011256:Pregnancy Outcome; D013203:Staphylococcal Infections / Q000635:transmission; D013290:Streptococcal Infections / Q000635:transmission; D013296:Streptococcus pneumoniae
D000900:Anti-Bacterial Agents; D004917:Erythromycin