RESPIRATORY INFECTION

Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study

M M van der Eerden¹, F Vlaspolder², C S de Graaff¹, T Groot², W Bronsveld³, H M Jansen⁴, W G Boersma¹

¹ Department of Pulmonary Diseases, Medical Centre Alkmaar, Alkmaar, the Netherlands
² Laboratory for Medical Microbiology, Medical Centre Alkmaar, Alkmaar, the Netherlands
³ Department of Internal Medicine, Medical Centre Alkmaar, Alkmaar, the Netherlands
⁴ Department of Pulmonary Diseases, Academic Medical Centre, Amsterdam, the Netherlands

Correspondence to:
Correspondence to:
Dr W G Boersma
Department of Pulmonary Diseases, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands; w.boersma{at}mca.nl

Background: There is much controversy about the ideal approach to the management of community acquired pneumonia (CAP). Recommendations differ from a pathogen directed approach to an empirical strategy with broad spectrum antibiotics.

Methods: In a prospective randomised open study performed between 1998 and 2000, a pathogen directed treatment (PDT) approach was compared with an empirical broad spectrum antibiotic treatment (EAT) strategy according to the ATS guidelines of 1993 in 262 hospitalised patients with CAP. Clinical efficacy was primarily determined by the length of hospital stay (LOS). Secondary outcome parameters for clinical efficacy were assessment of therapeutic failure on antibiotics, 30 day mortality, duration of antibiotic treatment, resolution of fever, side effects, and quality of life.

Results: Three hundred and three patients were enrolled in the study; 41 were excluded, leaving 262 with results available for analysis. No significant differences were found between the two treatment groups in LOS, 30 day mortality, clinical failure, or resolution of fever. Side effects, although they did not have a significant influence on the outcome parameters, occurred more frequently in patients in the EAT group than in those in the PDT group (60% v 17%, 95% CI –0.5 to –0.3; p<0.001).

Conclusions: An EAT strategy with broad spectrum antibiotics for the management of hospitalised patients with CAP has comparable clinical efficacy to a PDT approach.

Abbreviations: CAP, community acquired pneumonia; EAT, empirical broad spectrum antibiotic treatment; PDT, pathogen directed treatment

Keywords: community acquired pneumonia; antibiotic treatment strategy; guidelines; length of stay

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