Thorax 68:493-495 doi:10.1136/thoraxjnl-2012-202296
  • Chest clinic
  • Audit, research and guideline update

Single versus combination antibiotic therapy in adults hospitalised with community acquired pneumonia

  1. on behalf of the British Thoracic Society
  1. 1Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
  3. 3Department of Respiratory Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr Chamira Rodrigo, Department of Respiratory Medicine, City Campus, Nottingham University Hospitals NHS Trust, Nottingham NG51PB, UK, chamira{at}
  • Received 18 June 2012
  • Accepted 21 September 2012
  • Published Online First 16 October 2012


The benefits of β-lactam/macrolide combination therapy over β-lactam therapy alone for the treatment of hospitalised community-acquired pneumonia (CAP) in relation to pneumonia severity are uncertain. We studied 5240 adults hospitalised with CAP from 72 secondary care trusts across England and Wales. The overall 30-day inpatient (IP) death rate was 24.4%. Combination therapy was prescribed in 3239 (61.8%) patients. In a multivariable model, combination therapy was significantly associated with lower 30-day IP death rate in patients with moderate-severity CAP (adjusted OR 0.54, 95% CI 0.41 to 0.72) and high-severity CAP (adjusted OR 0.76, 95% CI 0.60 to 0.96) but not low-severity CAP.