HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

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 Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schaaf, B. Articles by Dalhoff, K. Search for Related Content PubMed Articles by Schaaf, B. Articles by Dalhoff, K.

From the authors

Medical Clinic III, University of Lübeck, Lübeck, Germany.

The authors would like to thank P. Charles for his interest in their recent article 1. His major point of criticism is that the finding of an association between pre-hospital treatment and outcome may lead to unnecessary antimicrobial usage in the ambulatory setting. P. Charles emphasises the role of host factors on outcome of pneumonia and cites a recent study evaluating community-acquired pneumonia (CAP) treatment failure 2. Host factors, namely neoplasia and neurological disease, were associated with CAP outcome 2. However, patients with previous antimicrobial treatment were excluded in the study by Genne et al. 2, thus it is impossible to know the impact of pre-hospital antibiotic therapy on outcome from the study. In our study, a less severe course of pneumococcal disease in patients with prior ambulatory treatment was found 1. As a randomised trial was not performed, data are clearly observational and open to confounding. Accordingly we did not claim that a causal relationship is proven by these findings. However, we think it worthwhile to discuss these seemingly provocative data as, in the pre-hospital phase of CAP, the duration and impact of treatment delay may be even larger than in the hospital setting, where most guidelines now recommend institution of treatment within 4–8 h after admission or "as soon as possible" 3.

Since the mortality of pneumococcal disease has not changed much over the past decades, new options for increasing survival are necessary. Several data, including ours and on the timing of in-hospital treatment 4, suggest a benefit from institution of antimicrobial therapy early in the course of disease. This has to be weighed against the potential of antibiotic misuse as outlined by P. Charles. Obviously more data, especially from randomised trials are needed to draw firm conclusions.

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. 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]
3. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44: Suppl. 2 S27–S72.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
4. Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004;164:637–644.[Abstract/Free Full Text]

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 Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schaaf, B. Articles by Dalhoff, K. Search for Related Content PubMed Articles by Schaaf, B. Articles by Dalhoff, K.