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Should third‐generation cephalosporins be the empirical treatment of choice for severe community‐acquired pneumonia in adults?
Author(s) -
Paterson David L,
Playford E Geoffrey
Publication year - 1998
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1998.tb138964.x
Subject(s) - cephalosporin , medicine , penicillin , azithromycin , pneumonia , community acquired pneumonia , ampicillin , antibiotics , intensive care medicine , haemophilus influenzae , regimen , microbiology and biotechnology , biology
The choice of empirical treatment for community‐acquired pneumonia (CAP) is highly controversial. Our survey of 42 Australian emergency department doctors showed that monotherapy with a third‐generation cephalosporin was the preferred regimen for severe CAP (14/42; 33%). We argue that cheaper regimens with a narrower spectrum are likely to be just as effective as third‐generation cephalosporins and will have fewer adverse effects on the microbial ecology of hospitals. We suggest penicillin or ampicillin (to cover pneumococci ‐ even if penicillin “resistant” ‐ and Haemophilus influenzae), plus a macrolide (eg, azithromycin or erythromycin; to cover Legionella and other “atypical” pathogens), plus a single large dose of an aminoglycoside (eg, gentamicin; to cover gram‐negative bacilli such as Klebsiella pneumoniae) as empirical therapy for severe CAP.