[Community-acquired pneumonia: usefulness of clinical presentation in the selection of antibiotic treatment].
BACKGROUND
Our purpose was to assess the usefulness of a strategy based on the clinical presentation in order to choose antibiotics in patients with non-severe community-acquired pneumonia (CAP).


METHODS
During one year, all patients admitted to the emergency department with a diagnosis of non-severe (Fine risk-classes I, II and III) CAP, were randomized and assigned into the following groups: GROUP 1: the clinical presentation was not taken into account and all patients were treated with levofloxacin; GROUP 2: patients with typical presentation were treated with amoxicillin and patients with atypical presentation were treated with clarithromycin. The following aspects were evaluated during the follow-up: presence of fever after 72 h of treatment, days of hospitalization and complications.


RESULTS
The eventual population analyzed included 125 patients: 59 (47%) were assigned to Group 1 and 66 (53%) to Group 2. Patients assigned to Group 1 had a lower rate of fever after 72 h of treatment (7% vs 27%, p = 0.005); they were hospitalized for fewer days (4.8 vs 8.1 days, p = 0.01), and had less complications: changes in antibiotic treatment (10% vs 23% p = NS), admissions in ICU (0% vs 5%, p = NS), re-admissions in hospital (0% vs 5%, p = 0.05) and mortality (0% vs 2%, p = NS).


CONCLUSIONS
A strategy of empiric treatment of non-severe CAP with levofloxacin as the antibiotic of choice is more useful than that of a treatment based on the clinical presentation.
Ruiz
Agustín
A
Servicio de Urgencias, Hospital Universitario Arnau de Vilanova, Lleida, Spain. med003272@saludalia.es
Falguera
Miquel
M
Sacristán
Oscar
O
Vallverdú
Montserrat
M
Cabré
Xavier
X
Pérez
Jesús
J
Ferrer
Gerard
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D010406:Penicillins / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D010406:Penicillins; D064704:Levofloxacin; D000658:Amoxicillin; D015242:Ofloxacin; D017291:Clarithromycin