Diagnosis and ambulatory treatment of patients with community acquired pneumonia: variability of complementary tests and study of roxithromycin effectiveness

Background, Community-acquired pneumonia (CAP) has been the subject of a nu mber of studies, Nevertheless, studies focused on effectiveness of therapy and variability of diagnostic tests are scarce, Patients and methods, Observational study of the diagnostic methodology use d in patients attending hospital Emergency Departments for possible CAP and assessment of effectiveness and reliability of empiric ambulatory therapy with roxithromycin (150 mg/12 h, for a minimum of ten days), The only manda ted complementary tests Included PA and lateral chest Pt-ray views and bloo d count, Microbiological tests Were left to the discretion of the attending physician, Clinical and biological follow-up of the patient consisted of t hree outpatient visits, Results, The study was conducted at 18 spanish hospitals from October 1997 to March 1998. The final total of patients with CAP enrolled was 161 (75 wo men and 86 men). Three patients required hospital admission, In a 3% of pat ients the Gram staining of the sputum specimen was performed; in 53% of pat ients blood cultures were obtained (3.4% were positive) and in 23% of patie nts serological determinations were performed (16.7% were positive), The fi nal microbiological results led to the disclosure of the etiologic agent of CAP in 5.5% of patients, In only one patient did the results prompt a chan ge in antibiotic therapy. The clinical course was favorable in 92.5% of pat ients, In 12 patients (7.5%) a change of antibiotic was made or a second an tibiotic was added, The mean therapy duration with roxithromycin was 11.9 d ays (range: 7-22 days), In five patients (3.1%), the observed adverse event s were attributed to roxithromycin, and in no case was discontinuation of t herapy necessary, Conclusions, The variability of diagnostic tests used in patients with CAP is remarkable but their yield is of little effect, Patients with CAP candid ates for ambulatory therapy can receive empiric antibiotic therapy with rox ithromycin, In this series, roxithromycin had a high clinical effectiveness and was well tolerated.