An appraisal of treatment guidelines for antepartum community-acquired pneumonia

OBJECTIVE: The optimal strategy for the initial evaluation and management, including criteria for hospitalization, of pregnant women with pneumonia ha s not been defined. Our purpose was to evaluate a treatment protocol for an tepartum pneumonia and to identify criteria for selection of women for pote ntial outpatient treatment. STUDY DESIGN: A protocol based on British and American Thoracic Society gui delines was introduced and included prompt hospitalization and empiric init iation of erythromycin therapy. Maternal and neonatal outcomes were analyze d to assess the efficacy of the protocol. A second analysis involved the re trospective application of published guidelines to ascertain for which wome n outpatient management might have been appropriate. RESULTS: There were no maternal deaths among the 133 women studied, and in 14 (10%) women there was a misdiagnosis at admission. Erythromycin monother apy was judged adequate in all but one of the 99 women so treated. Using a modified version of the American Thoracic Society guidelines, we project th at only 25% of the women hospitalized with pneumonia could have been manage d safely as outpatients. CONCLUSION: Most pregnant women with pneumonia respond well to monotherapy with erythromycin. Outpatient management may be a reasonable option for sel ected women.