EMPIRICAL THERAPY FOR NONHOSPITALIZED PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

A prospective survey involving a group of 95 general practitioners (GP s) in France was conducted to describe antibiotic therapy prescribed f or outpatients 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 infe ction, were reported between February 1993 and March 1994: 84 males an d 89 females (mean age: 48 yrs) of whom 45% had no underlying disease, Nineteen (11%) were immediately hospitalized and the remaining 154 ou t-patients were treated without microbiological investigation. First-l ine antibiotic therapy was amoxicillin or amoxicillin-clavulanic acid combination (57%), a first or second generation cephalosporin (12%), c eftriaxone (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%) patie nts failed to improve: 18 were hospitalized and 16 had a second-line t herapy, mainly a macrolide or a quinolone, Five patients died at hospi tal, The overall mortality was 3%,and 14% in hospitalized patients, Em pirical therapy using a betalactam to target a presumed pneumococcal i nfection, in agreement with European guidelines, is appropriate for ou t-patients with mild lobar community-acquired pneumonia.