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Oral antibiotics prior to hospitalisation for community-acquired pneumonia

Dept of Infectious Diseases, Austin Health, Heidelberg, Australia.

To the Editor:

Schaaf et al. 1 postulate that antibiotics prior to hospitalisation with community-acquired pneumonia may be protective because of a slightly lower death rate and lower C-reactive protein concentration, leukocyte count and acute physiology score in the 13 out of 105 patients that received them. Since Austrian and Gold 2 demonstrated a reduction in mortality from 80 to 17% in bacteraemic pneumococcal infections treated with penicillin, the death rate for this condition has changed little. A 2006 study has suggested that deaths in patients with community-acquired pneumonia are far more likely to be due to host factors rather than antibiotic choices 3.

It is possible that such host factors could lead to some patients having better outcomes, subacute presentations and more time before hospitalisation in which to receive oral antibiotics. Conversely, those patients with worse outcomes may show more acute presentations, removing the option of pre-hospitalisation antibiotics. Information on the number of days that patients were unwell prior to admission may help to answer this in part. Given the inaccuracy with which doctors make the diagnosis of community-acquired pneumonia, this is an important point 4–6, since pharmaceutical companies might be predicted to use potentially misleading conclusions such as this to encourage primary care physicians to prescribe antibiotics to anyone who might have community-acquired pneumonia, with potential for increased levels of antibiotic resistance, unnecessary costs and potential side-effects.

Statement of interest

None declared.

REFERENCES

1. Schaaf B, Kruse J, Rupp J, et al. Sepsis severity predicts outcome in community-acquired pneumococcal pneumonia. Eur Respir J 2007;30:517–524.[Abstract/Free Full Text]
2. Austrian R, Gold J. Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia. Ann Intern Med 1964;60:759–776.[Web of Science][Medline] [Order article via Infotrieve]
3. Genne D, Sommer R, Kaiser L, et al. Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2006;25:159–166.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
4. Campbell SG, Murray DD, Hawass A, Urquhart D, Ackroyd-Stolarz S, Maxwell D. Agreement between emergency physician diagnosis and radiologist reports in patients discharged from an emergency department with community-acquired pneumonia. Emerg Radiol 2005;11:242–246.[CrossRef][Medline] [Order article via Infotrieve]
5. Kanwar M, Brar N, Khatib R, Fakih MG. Misdiagnosis of community-acquired pneumonia and inappropriate utilization of antibiotics: side effects of the 4-h antibiotic administration rule. Chest 2007;131:1865–1869.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
6. Novack V, Avnon LS, Smolyakov A, Barnea R, Jotkowitz A, Schlaeffer F. Disagreement in the interpretation of chest radiographs among specialists and clinical outcomes of patients hospitalized with suspected pneumonia. Eur J Intern Med 2006;17:43–47.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Permissions Request Permissions Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Charles, P. G. P. Search for Related Content PubMed PubMed Citation Articles by Charles, P. G. P.