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Inpatient care of community-acquired pneumonia: DISCUSSION (3)

pneumonia

There are several noteworthy observations regarding the use of specific antibiotics — buy ampicillin. The choice of antibiotic therapy was associated with illness severity. There was progressively increasing severity, measured by the PSI, in cases treated with macrolide monotherapy, cephalosporin or levofloxacin monotherapy, cephalosporin plus a macrolide and antianaerobe agents. Empirical treatment with antianaerobe agents or cephalosporin plus a macrolide was associated with higher mortality (odds ratio 2.7 for both), despite controlling for PSI score. These data provide an interesting comparison with those of Gleason et al. Similar to our experience of increased mortality in patients treated with antianaerobe agents, Gleason et al observed higher mortality in patients treated with beta-lactam/beta-lactam inhibitor combinations. Also, Mortensen et al recently reported aspiration pneumonia as an independent risk factor for mortality in CAP, with a hazard ratio of 3.1, which is a risk magnitude similar to what we observed in patients treated with anaerobic coverage. In contrast to our experience regarding cephalosporin and macrolide combination therapy, Gleason et al observed lower mortality in patients receiving this regimen. The latter observation was pivotal in supporting the belief that atypical agents are important for patients with CAP. This belief was reflected in the IDSA CAP guidelines published in 2000, when the addition of a macrolide was first made mandatory.