At least 1.3 million people are admitted to the hospital with pneumonia each year in the United States, and approximately 10% of these patients will die within 30 days of admission.2 Many questions remain about the optimum empiric antibiotic treatment of patients with community-acquired pneumonia, as well as the treatment of patients in whom a causative organism is identified. A major area of debate is the role of agents that are active against “atypical” organisms. While several observational studies have demonstrated improved outcomes associated with atypical coverage, and pneumonia treatment guidelines recommend such treatment a recent metaanalysis and systematic review of randomized, controlled trials failed to demonstrate an advantage of this practice. Improved outcomes associated with atypical treatment in patients with pneumococcal bacteremia have also been report-ed, but there is poor understanding of the mechanism by which atypical coverage could improve outcomes when an alternative pathogen is identified. Possible mechanisms could include treatment of dual infection with an atypical pathogen such as Chlamydophila pneumoniae,14 the immunomodulatory effects of macrolide and fluoroquinolone antibiotics, or the achievement of broader coverage against unusual or resistant pathogens when these antibiotics are used in combination with (3-lactam antibiotics.
In order to better understand the effect of atypical antibiotic coverage in patients who are admitted to the hospital with pneumonia, we studied the relationship between the initial antibiotic regimen and several patient outcomes in a large cohort of Medicare beneficiaries who were hospitalized with bacteremic pneumonia. The large size of this cohort provided the unique opportunity to compare the effects of fluoroquinolones and macrolides. Because > 60% of the cases in this cohort were patients who were infected with an organism other than Streptococcus pneumoniae, this analysis also provided the opportunity to expand on the observations of prior studies that were limited to patients with pneumococcal bacteremia. Such kind of pneumonia may be treated if you order drugs via Canadian Neighbor Pharmacy. This online pharmacy is the best choice for you.
The data analyzed were part of the Medicare National Pneumonia Project, which is a component of the Medicare Quality Improvement Program. Therefore, neither informed consent nor institutional review board approval were required. Eligible patients were fee-for-service Medicare beneficiaries who had been discharged from the hospital between 1998 and 2001 with a principal diagnosis of pneumonia, and those with a principal diagnosis of septicemia or respiratory failure and a secondary diagnosis of pneumonia. Patients included in the study were admitted to the hospital from either home or a nursing facility. The details regarding the selection of the cohort used in this study, the data collection and validation methods have been previously described in detail.