Empirical therapy for nonhospitalized patients with community-acquired pneumonia. Study Group of General Practitioners

Abstract

A prospective survey involving a group of 95 general practitioners (GPs) in France was conducted to describe antibiotic therapy prescribed for out-patients with community-acquired pneumonia (CAP). A total of 173 cases of CAP, defined by the association of fever and pulmonary focal crackles and/or radiological changes consistent with a pulmonary infection, were reported between February 1993 and March 1994: 84 males and 89 females (mean age: 48 yrs) of whom 45% had no underlying disease. Nineteen (11%) were immediately hospitalized and the remaining 154 out-patients were treated without microbiological investigation. First-line antibiotic therapy was amoxicillin or amoxicillin-clavulanic acid combination (57%), a first or second generation cephalosporin (12%), ceftriaxone (8%), oral broad-spectrum cephalosporin (3%), a macrolide (16%), a tetracycline (1%) and a fluoroquinolone (2%). A total of 120 (78%) patients recovered with no change in treatment and 34 (22%) patients failed to improve: 18 were hospitalized and 16 had a second-line therapy, mainly a macrolide or a quinolone. Five patients died at hospital. The overall mortality was 3%, and 14% in hospitalized patients. Empirical therapy using a betalactam to target a presumed pneumococcal infection, in agreement with European guidelines, is appropriate for out-patients with mild lobar community-acquired pneumonia.

Clinical Characteristics and Outcome of Patients with Invasive Pneumococcal Disease, Puy-de-Dôme, France, 1994–1998

“…Since pneumococcal bacteremia represents most cases of IPD (87% in our study), case ascertainment depends on the rate of blood culture sampling for patients with CAP before antibiotic treatment [38]. In France, blood cultures are not routinely obtained from nonhospitalized patients with CAP [23].…”

“…A previous survey carried out among general practitioners in our region showed that blood cultures and sputum examinations were not routinely obtained in ambulatory patients with CAP [23], and that patients were simply treated empirically following European and national guidelines [24,25].…”

GP management of community-acquired pneumonia in Italy: the ISOCAP study

“…Most subjects affected with pneumonia, especially those without risk factors, are treated at home, but not many studies concerning the diagnostic and therapeutic approach to CAP in the outpatient setting have been published [5][6][7][8][9].…”

Evaluación y manejo del adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad, en un hospital de baja complejidad, basado en la Guía Clínica Chilena

“…En estudios poblacionales, se ha estimado que alrededor de 70% a 80% de los episodios de neumonía adquirida en la comunidad (NAC) son tratados en el ámbito ambulatorio, dado el bajo riesgo de complicaciones y muerte (letalidad inferior a 1%-2%) y sólo 20% a 30% requiere manejo hospitalario por la gravedad del cuadro, concentrándose en esta población el mayor riesgo de complicaciones, muerte y demanda de recursos de salud [3][4][5] . Este último grupo corresponde principalmente, a adultos mayores de 65 años o portadores de enfermedades crónicas.…”