Single vs Multiple Antibiotics in Community-Acquired Pneumonia

By Richard G. Wunderink, MD, FCCP; and Grant W. Waterer, MBBS, FCCP

Conclusions

At the present time, the optimal therapy for patients with CAP remains debatable. For empiric treatment of hospitalized patients with CAP, regimens that include coverage of the atypical microorganisms and the possibility of penicillin-resistant S pneumoniae consistently show better outcome. This can be achieved with combination regimens; with monotherapy, only the newer generation of fluoroquinolones consistently provides adequate coverage. Monotherapy with the newer-generation macrolides in areas with low levels of resistance is possible but increasingly dangerous. Antibiotic prescription heterogeneity or rotation may actually be beneficial in avoiding increasing resistance. Therefore, use of both combination regimens and quinolone monotherapy should be encouraged.

As recommended in the most recent guidelines,^1,2 combination therapy should be the rule in patients with severe CAP. Even if the pneumococcus is found to be the causative microorganism, initial combination therapy appears to be beneficial. Any hint of Gram-negative CAP should be treated with aminoglycoside or ciprofloxacin combination therapy because of the significantly increased mortality rates associated with these etiologies.

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