engleski

TREATMENT OF COMMUNITY ACQUIRED PNEUMONIA – AN INTENSIVIST PERSPECTIVE

Severe pneumonia treated in intensive care units (ICU) represents a great therapeutic challenge. Usual defervescence of fever does not occur as in other patients, particularly not in mechanically ventilated patients. We evaluated 30 consecutive patients with community acquired pneumonia admitted in the ICU. Initial therapy was azithromycin intravenously for seven days plus beta-lactams (ceftriaxon or penicillin). Switch to oral treatment was possible after defervescence of fever. Treatment was finished as planned in 25 patients. In five patients it was stopped because of early therapeutic failure, isolation of resistant pathogens or adverse drug event. However, in 10/25 patients which completed planned treatment additional antibiotics were added despite improvement of pneumonia because of suspected or confirmed nosocomial infection. Six patients died during hospitalisation. Treatment beta-lactams plus azithromycin was successful in 21 patients. Analysis of duration of fever in survivors showed that only in one patient defervescence of fever occurred after three days of treatment. Our results suggest that randomised clinical studies overestimate clinical efficacy of antibiotics due to the selection of patients, even with severe pneumonia. Evaluation of treatment effect should be based more on meticulous estimation of respiratory function than on parameters representing systemic inflammatory response or x-ray findings.

CAP; azithromycin; quinolones; mechanical ventilation

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