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Published in: Critical Care 1/2006

01-02-2006 | Commentary

Choosing the right combination therapy in severe community-acquired pneumonia

Authors: Grant W Waterer, Jordi Rello

Published in: Critical Care | Issue 1/2006

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Abstract

Recent studies have suggested that combination antibiotic therapy is preferable to monotherapy for severe community-acquired pneumonia (CAP). In this issue Mortensen and colleagues present retrospective data suggesting that combination therapy with a cephalosporin and a fluoroquinolone is inferior to combination therapy with a cephalosporin and a macrolide. Several mechanisms exist by which quinolones could be inferior to macrolides in combination therapy, so if these findings are confirmed by other groups they have significant implications for physicians treating patients with severe CAP.
Literature
1.
go back to reference Mufson MA, Stanek RJ: Bacteremic pneumococcal pneumonia in one American City: a 20-year longitudinal study, 1978–1997. Am J Med 1999, 107: 34S-43S. 10.1016/S0002-9343(99)00098-4CrossRefPubMed Mufson MA, Stanek RJ: Bacteremic pneumococcal pneumonia in one American City: a 20-year longitudinal study, 1978–1997. Am J Med 1999, 107: 34S-43S. 10.1016/S0002-9343(99)00098-4CrossRefPubMed
2.
go back to reference Waterer GW, Somes GW, Wunderink RG: Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Arch Intern Med 2001, 161: 1837-1842. 10.1001/archinte.161.15.1837CrossRefPubMed Waterer GW, Somes GW, Wunderink RG: Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Arch Intern Med 2001, 161: 1837-1842. 10.1001/archinte.161.15.1837CrossRefPubMed
3.
go back to reference Martinez JA, Horcajada JP, Almela M, Marco F, Soriano A, Garcia E, Marco MA, Torres A, Mensa J: Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 2003, 36: 389-395. 10.1086/367541CrossRefPubMed Martinez JA, Horcajada JP, Almela M, Marco F, Soriano A, Garcia E, Marco MA, Torres A, Mensa J: Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 2003, 36: 389-395. 10.1086/367541CrossRefPubMed
4.
go back to reference Baddour LM, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, Morris AJ, Luna CM, Snydman DR, Ko WC, et al.: Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 2004, 170: 440-444. 10.1164/rccm.200311-1578OCCrossRefPubMed Baddour LM, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, Morris AJ, Luna CM, Snydman DR, Ko WC, et al.: Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 2004, 170: 440-444. 10.1164/rccm.200311-1578OCCrossRefPubMed
5.
go back to reference Weiss K, Low DE, Cortes L, Beaupre A, Gauthier R, Gregoire P, Legare M, Nepveu F, Thibert D, Tremblay C, et al.: Clinical characteristics at initial presentation and impact of dual therapy on the outcome of bacteremic Streptococcus pneumoniae pneumonia in adults. Can Respir J 2004, 11: 589-593.PubMed Weiss K, Low DE, Cortes L, Beaupre A, Gauthier R, Gregoire P, Legare M, Nepveu F, Thibert D, Tremblay C, et al.: Clinical characteristics at initial presentation and impact of dual therapy on the outcome of bacteremic Streptococcus pneumoniae pneumonia in adults. Can Respir J 2004, 11: 589-593.PubMed
6.
go back to reference Dudas V, Hopefl A, Jacobs R, Guglielmo BJ: Antimicrobial selection for hospitalized patients with presumed community-acquired pneumonia: a survey of nonteaching US community hospitals. Ann Pharmacother 2000, 34: 446-452. 10.1345/aph.19174CrossRefPubMed Dudas V, Hopefl A, Jacobs R, Guglielmo BJ: Antimicrobial selection for hospitalized patients with presumed community-acquired pneumonia: a survey of nonteaching US community hospitals. Ann Pharmacother 2000, 34: 446-452. 10.1345/aph.19174CrossRefPubMed
7.
go back to reference Brown RB, Iannini P, Gross P, Kunkel M: Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database. Chest 2003, 123: 1503-1511. 10.1378/chest.123.5.1503CrossRefPubMed Brown RB, Iannini P, Gross P, Kunkel M: Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database. Chest 2003, 123: 1503-1511. 10.1378/chest.123.5.1503CrossRefPubMed
8.
go back to reference Houck PM, MacLehose RF, Niederman MS, Lowery JK: Empiric antibiotic therapy and mortality among medicare pneumonia inpatients in 10 western states: 1995, and 1997. Chest 2001, 119: 1420-1426. 10.1378/chest.119.5.1420CrossRefPubMed Houck PM, MacLehose RF, Niederman MS, Lowery JK: Empiric antibiotic therapy and mortality among medicare pneumonia inpatients in 10 western states: 1995, and 1997. Chest 2001, 119: 1420-1426. 10.1378/chest.119.5.1420CrossRefPubMed
9.
go back to reference Garcia Vazquez E, Mensa J, Martinez JA, Marcos MA, Puig J, Ortega M, Torres A: Lower mortality among patients with community-acquired pneumonia treated with a macrolide plus a beta-lactam agent versus a beta-lactam agent alone. Eur J Clin Microbiol Infect Dis 2005, 24: 190-195. 10.1007/s10096-005-1295-9CrossRefPubMed Garcia Vazquez E, Mensa J, Martinez JA, Marcos MA, Puig J, Ortega M, Torres A: Lower mortality among patients with community-acquired pneumonia treated with a macrolide plus a beta-lactam agent versus a beta-lactam agent alone. Eur J Clin Microbiol Infect Dis 2005, 24: 190-195. 10.1007/s10096-005-1295-9CrossRefPubMed
10.
go back to reference Mortensen EM, Restrepo MI, Anzueto A, Pugh J: The impact of empiric antimicrobial therapy with a β-lactam and fluoroquinolone on mortality for patients hospitalized with severe pneumonia. Crit Care 2006, 10: R8. 10.1186/cc3934PubMedCentralCrossRef Mortensen EM, Restrepo MI, Anzueto A, Pugh J: The impact of empiric antimicrobial therapy with a β-lactam and fluoroquinolone on mortality for patients hospitalized with severe pneumonia. Crit Care 2006, 10: R8. 10.1186/cc3934PubMedCentralCrossRef
11.
go back to reference Lagrou K, Peetermans WE, Jorissen M, Verhaegen J, Van Damme J, Van Eldere J: Subinhibitory concentrations of erythromycin reduce pneumococcal adherence to respiratory epithelial cells in vitro. J Antimicrob Chemother 2000, 46: 717-723. 10.1093/jac/46.5.717CrossRefPubMed Lagrou K, Peetermans WE, Jorissen M, Verhaegen J, Van Damme J, Van Eldere J: Subinhibitory concentrations of erythromycin reduce pneumococcal adherence to respiratory epithelial cells in vitro. J Antimicrob Chemother 2000, 46: 717-723. 10.1093/jac/46.5.717CrossRefPubMed
12.
go back to reference Parnham MJ: Immunomodulatory effects of antimicrobials in the therapy of respiratory tract infections. Curr Opin Infect Dis 2005, 18: 125-131. 10.1097/01.qco.0000160901.71813.feCrossRefPubMed Parnham MJ: Immunomodulatory effects of antimicrobials in the therapy of respiratory tract infections. Curr Opin Infect Dis 2005, 18: 125-131. 10.1097/01.qco.0000160901.71813.feCrossRefPubMed
13.
go back to reference Sabria M, Pedro-Botet ML, Gomez J, Roig J, Vilaseca B, Sopena N, Banos V: Fluoroquinolones vs macrolides in the treatment of Legionnaires disease. Chest 2005, 128: 1401-1405. 10.1378/chest.128.3.1401CrossRefPubMed Sabria M, Pedro-Botet ML, Gomez J, Roig J, Vilaseca B, Sopena N, Banos V: Fluoroquinolones vs macrolides in the treatment of Legionnaires disease. Chest 2005, 128: 1401-1405. 10.1378/chest.128.3.1401CrossRefPubMed
14.
go back to reference Williams AC, Galley HF, Watt AM, Webster NR: Differential effects of three antibiotics on T helper cell cytokine expression. J Antimicrob Chemother 2005, 56: 502-506. 10.1093/jac/dki251CrossRefPubMed Williams AC, Galley HF, Watt AM, Webster NR: Differential effects of three antibiotics on T helper cell cytokine expression. J Antimicrob Chemother 2005, 56: 502-506. 10.1093/jac/dki251CrossRefPubMed
15.
go back to reference Culic O, Erakovic V, Cepelak I, Barisic K, Brajsa K, Ferencic Z, Galovic R, Glojnaric I, Manojlovic Z, Munic V, et al.: Azithromycin modulates neutrophil function and circulating inflammatory mediators in healthy human subjects. Eur J Pharmacol 2002, 450: 277-289. 10.1016/S0014-2999(02)02042-3CrossRefPubMed Culic O, Erakovic V, Cepelak I, Barisic K, Brajsa K, Ferencic Z, Galovic R, Glojnaric I, Manojlovic Z, Munic V, et al.: Azithromycin modulates neutrophil function and circulating inflammatory mediators in healthy human subjects. Eur J Pharmacol 2002, 450: 277-289. 10.1016/S0014-2999(02)02042-3CrossRefPubMed
16.
go back to reference Shinkay M, Park CS, Rubin BK: Immunomodulatory effects of macrolide antibiotics. Clin Pulm Med 2005, 12: 341-348. 10.1097/01.cpm.0000187294.53696.c0CrossRef Shinkay M, Park CS, Rubin BK: Immunomodulatory effects of macrolide antibiotics. Clin Pulm Med 2005, 12: 341-348. 10.1097/01.cpm.0000187294.53696.c0CrossRef
17.
go back to reference Dalhoff A, Shalit I: Immunomodulatory effects of quinolones. Lancet Infect Dis 2003, 3: 359-371. 10.1016/S1473-3099(03)00658-3CrossRefPubMed Dalhoff A, Shalit I: Immunomodulatory effects of quinolones. Lancet Infect Dis 2003, 3: 359-371. 10.1016/S1473-3099(03)00658-3CrossRefPubMed
18.
go back to reference Rello J, Diaz E, Bodi M, Catalan M, Alvarez B: Associations between empirical antimicrobial therapy at the hospital and mortality in patients with severe community-acquired pneumonia. Intensive Care Med 2003, 28: 1030-1035.CrossRef Rello J, Diaz E, Bodi M, Catalan M, Alvarez B: Associations between empirical antimicrobial therapy at the hospital and mortality in patients with severe community-acquired pneumonia. Intensive Care Med 2003, 28: 1030-1035.CrossRef
19.
go back to reference Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ: Associations between initial antimicrobial therapy and medical outcomes for hospitalized patients with pneumonia. Arch Intern Med 1999, 159: 2562-2572. 10.1001/archinte.159.21.2562CrossRefPubMed Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ: Associations between initial antimicrobial therapy and medical outcomes for hospitalized patients with pneumonia. Arch Intern Med 1999, 159: 2562-2572. 10.1001/archinte.159.21.2562CrossRefPubMed
20.
go back to reference Bodi M, Rodriguez A, Sole-Violan J, Gilavert MC, Garnacho J, Blanquer J, Jimenez J, de la Torre MV, Sirvent JM, Almirall J, et al.: Antibiotic prescribing for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America Guidelines on survival. Clin Infect Dis 2005, 41: 1709-1716. 10.1086/498119CrossRefPubMed Bodi M, Rodriguez A, Sole-Violan J, Gilavert MC, Garnacho J, Blanquer J, Jimenez J, de la Torre MV, Sirvent JM, Almirall J, et al.: Antibiotic prescribing for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America Guidelines on survival. Clin Infect Dis 2005, 41: 1709-1716. 10.1086/498119CrossRefPubMed
Metadata
Title
Choosing the right combination therapy in severe community-acquired pneumonia
Authors
Grant W Waterer
Jordi Rello
Publication date
01-02-2006
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc3976

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