[Community acquired pneumonia; no reason to revise current Dutch antibiotic guidelines].
Community-acquired pneumonia is an important cause of hospital admission and mortality in the adult population. The recommended antibiotic for pneumonia caused by Streptococcus pneumoniae is a beta-lactam antibiotic and, for so-called atypical pathogens, a macrolide. In the US and elsewhere, the current recommendation is to start with a beta-lactam antibiotic and a macrolide or with one of the new quinolones. The available literature consists largely of retrospective studies. Because of possible selection bias in these analyses and inconsistencies in reported outcomes, it is not possible to draw any well-founded conclusions from these studies. Reasons for a possible additional benefit of adding a macrolide to the therapy could include: a higher prevalence of undiagnosed atypical pathogens, the anti-inflammatory effects of macrolides, and resistance of the main pathogens against beta-lactam antibiotics. None of these appear to play a significant role. There is no need to revise Dutch guidelines.
Oosterheert
J J
JJ
Universitair Medisch Centrum, afd. Acute Geneeskunde en Infectieziekten, Postbus 85.500, 3508 GA Utrecht.
Bonten
M J M
MJ
Schneider
M M E
MM
Hoepelman
I M
IM
D042462:4-Quinolones; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004338:Drug Combinations; D024881:Drug Resistance, Bacterial; D006801:Humans; D007769:Lactams; D018942:Macrolides; D009426:Netherlands; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D016896:Treatment Outcome
D042462:4-Quinolones; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D004338:Drug Combinations; D007769:Lactams; D018942:Macrolides