title: Monotherapy versus dual therapy for community-acquired pneumonia in hospitalized patients.
abstract: Several medical-specialty professional societies have suggested that combination therapy with a beta -lactam plus a macrolide or doxycycline or monotherapy with a "respiratory quinolone" (i.e., levofloxacin, gatifloxacin, moxifloxacin, or gemifloxacin) are optimal first-line therapy for patients hospitalized with community-acquired pneumonia. These recommendations are based predominantly on retrospective studies that suggest improved rates of morbidity and mortality and hospital length of stay among patients treated in such a fashion. Well-designed, prospective, randomized studies confirming this tenet of therapy have not been published, although numerous prospective studies have provided indirect confirmation. The biological rationale for such a differential response (i.e., favoring combination therapy or fluoroquinolone therapy) includes the immunomodulatory effects of macrolides or more-optimal treatment of primary infection or coinfection with atypical pathogens. Well-designed, prospective, randomized trials are required to best define the effectiveness of combination therapy with a beta -lactam plus macrolide or doxycycline or with a respiratory quinolone in hospitalized patients with community-acquired pneumonia.
authors.affiliation: Division of Pulmonary and Critical Care, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0360, USA. fmartine@umich.edu
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Martinez
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001372:Aza Compounds / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones / Q000627:therapeutic use; D000077734:Gatifloxacin; D000077735:Gemifloxacin; D006760:Hospitalization; D006801:Humans; D064704:Levofloxacin; D018942:Macrolides / Q000627:therapeutic use; D000077266:Moxifloxacin; D009287:Naphthyridines / Q000627:therapeutic use; D015242:Ofloxacin / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D011804:Quinolines / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D000890:Anti-Infective Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D018942:Macrolides; D009287:Naphthyridines; D011804:Quinolines; D064704:Levofloxacin; D015242:Ofloxacin; D000077734:Gatifloxacin; D004318:Doxycycline; D000077735:Gemifloxacin; D000077266:Moxifloxacin