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Title: The etiology of community-acquired pneumonia in Australia: why penicillin plus doxycycline or a macrolide is the most appropriate therapy.
Austin Authors: Charles, Patrick G P ;Whitby, Michael;Fuller, Andrew J;Stirling, Robert;Wright, Alistair A;Korman, Tony M;Holmes, Peter W;Christiansen, Keryn J;Waterer, Grant W;Pierce, Robert J;Mayall, Barrie C;Armstrong, John G;Catton, Michael G;Nimmo, Graeme R;Johnson, Barbara;Hooy, Michelle;Grayson, M Lindsay 
Institutional Author: Australian CAP Study Collaboration
Affiliation: Infectious Diseases
Issue Date: 15-May-2008
Publication information: Clinical Infectious Diseases; 46(10): 1513-21
Abstract: 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.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.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 beta-lactams, and they did not differ on the basis of whether a pathogen was identified.The vast majority of patients with CAP can be treated successfully with narrow-spectrum beta-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.
DOI: 10.1086/586749
Journal: Clinical Infectious Diseases
Type: Journal Article
Subjects: Adolescent
Aged, 80 and over
Anti-Bacterial Agents.therapeutic use
Bacteria.drug effects.isolation & purification
Ceftriaxone.therapeutic use
Community-Acquired Infections.epidemiology.microbiology.mortality.virology
Doxycycline.therapeutic use
Guideline Adherence.statistics & numerical data
Macrolides.therapeutic use
Microbial Sensitivity Tests
Middle Aged
Penicillins.therapeutic use
Pneumonia, Bacterial.epidemiology.microbiology.mortality
Pneumonia, Viral.epidemiology.mortality.virology
Prospective Studies
Treatment Outcome
Viruses.isolation & purification
Appears in Collections:Journal articles

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