Single vs Multiple Antibiotics in Community-Acquired Pneumonia

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

An even stronger argument for the same selective bias can be made for the excess mortality associated with any aminoglycoside-containing combination regimen. Use of aminoglycosides clearly suggests a suspicion of a Gram-negative microorganism as the etiology of CAP, which has been clearly associated with a higher mortality.¹⁴

In summary, for CAP in which the etiology is not known, adequate coverage of both S pneumoniae and atypical microorganisms is associated with better outcome. At the present time, only the newer-generation quinolones can consistently provide adequate monotherapy. However, with increasing use, higher rates of resistance may make this untrue in the future.¹⁸ This phenomenon has already occurred with the newer-generation macrolides in many areas. The fallback position if high-level quinolone resistance becomes common is use of combination therapy.

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