Dr Charles studied almost 900 people admitted to six Australian hospitals over 28 months from 2004 to 2006.
Only 5 per cent of people admitted to hospital with community-acquired pneumonia had infections caused by organisms that could not be successfully treated with penicillin combined with an "atypical" antibiotic such as doxycycline or erythromycin. He found that most cases of pneumonia were caused by easy to treat bacteria such as the pneumococcus or Mycoplasma, or alternatively by respiratory viruses that do not require antibiotic therapy.
Dr Charles said the trend towards broad-spectrum antibiotics was being driven by laboratory-based studies of resistance rates in bacteria sent to the labs, rather than clinical studies of patients with pneumonia. In the laboratory-based studies, the bacterial isolates often come from highly selected patients with more difficult to treat disease. In addition, the fear of litigation made some doctors unnecessarily opt for more aggressive treatments.
Complete article:
http://www.sciencedaily.com/releases/2008/08/080826124405.htm
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Summary of the study:http://www.journals.uchicago.edu/doi/abs/10.1086/586749
The Etiology of Community-Acquired Pneumonia in Australia: Why Penicillin plus Doxycycline or a Macrolide Is the Most Appropriate Therapy
Background. Available data on the etiology of community-acquired pneumonia (CAP) in Australia are very limited. Local treatment guidelines promote the use of combination therapy with agents such as penicillin or amoxycillin combined with either doxycycline or a macrolide.
Methods. The Australian CAP Study (ACAPS) was a prospective, multicenter study of 885 episodes of CAP in which all patients underwent detailed assessment for bacterial and viral pathogens (cultures, urinary antigen testing, serological methods, and polymerase chain reaction). Antibiotic agents and relevant clinical outcomes were recorded.
Results. The etiology was identified in 404 (45.6%) of 885 episodes, with the most frequent causes being Streptococcus pneumoniae (14%), Mycoplasma pneumoniae (9%), and respiratory viruses (15%; influenza, picornavirus, respiratory syncytial virus, parainfluenza virus, and adenovirus). Antibiotic-resistant pathogens were rare: only 5.4% of patients had an infection for which therapy with penicillin plus doxycycline would potentially fail. Concordance with local antibiotic recommendations was high (82.4%), with the most commonly prescribed regimens being a penicillin plus either doxycycline or a macrolide (55.8%) or ceftriaxone plus either doxycycline or a macrolide (36.8%). The 30-day mortality rate was 5.6% (50 of 885 episodes), and mechanical ventilation or vasopressor support were required in 94 episodes (10.6%). Outcomes were not compromised by receipt of narrower-spectrum β-lactams, and they did not differ on the basis of whether a pathogen was identified.
Conclusions. The vast majority of patients with CAP can be treated successfully with narrow-spectrum β-lactam treatment, such as penicillin combined with doxycycline or a macrolide. Greater use of such therapy could potentially reduce the emergence of antibiotic resistance among common bacterial pathogens.
Only 5 per cent of people admitted to hospital with community-acquired pneumonia had infections caused by organisms that could not be successfully treated with penicillin combined with an "atypical" antibiotic such as doxycycline or erythromycin. He found that most cases of pneumonia were caused by easy to treat bacteria such as the pneumococcus or Mycoplasma, or alternatively by respiratory viruses that do not require antibiotic therapy.
Dr Charles said the trend towards broad-spectrum antibiotics was being driven by laboratory-based studies of resistance rates in bacteria sent to the labs, rather than clinical studies of patients with pneumonia. In the laboratory-based studies, the bacterial isolates often come from highly selected patients with more difficult to treat disease. In addition, the fear of litigation made some doctors unnecessarily opt for more aggressive treatments.
Complete article:
http://www.sciencedaily.com/releases/2008/08/080826124405.htm
--------------------------------------------------------------------
Summary of the study:http://www.journals.uchicago.edu/doi/abs/10.1086/586749
The Etiology of Community-Acquired Pneumonia in Australia: Why Penicillin plus Doxycycline or a Macrolide Is the Most Appropriate Therapy
Background. Available data on the etiology of community-acquired pneumonia (CAP) in Australia are very limited. Local treatment guidelines promote the use of combination therapy with agents such as penicillin or amoxycillin combined with either doxycycline or a macrolide.
Methods. The Australian CAP Study (ACAPS) was a prospective, multicenter study of 885 episodes of CAP in which all patients underwent detailed assessment for bacterial and viral pathogens (cultures, urinary antigen testing, serological methods, and polymerase chain reaction). Antibiotic agents and relevant clinical outcomes were recorded.
Results. The etiology was identified in 404 (45.6%) of 885 episodes, with the most frequent causes being Streptococcus pneumoniae (14%), Mycoplasma pneumoniae (9%), and respiratory viruses (15%; influenza, picornavirus, respiratory syncytial virus, parainfluenza virus, and adenovirus). Antibiotic-resistant pathogens were rare: only 5.4% of patients had an infection for which therapy with penicillin plus doxycycline would potentially fail. Concordance with local antibiotic recommendations was high (82.4%), with the most commonly prescribed regimens being a penicillin plus either doxycycline or a macrolide (55.8%) or ceftriaxone plus either doxycycline or a macrolide (36.8%). The 30-day mortality rate was 5.6% (50 of 885 episodes), and mechanical ventilation or vasopressor support were required in 94 episodes (10.6%). Outcomes were not compromised by receipt of narrower-spectrum β-lactams, and they did not differ on the basis of whether a pathogen was identified.
Conclusions. The vast majority of patients with CAP can be treated successfully with narrow-spectrum β-lactam treatment, such as penicillin combined with doxycycline or a macrolide. Greater use of such therapy could potentially reduce the emergence of antibiotic resistance among common bacterial pathogens.