This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Boussekey, N. Articles by Guery, B. Search for Related Content PubMed PubMed Citation Articles by Boussekey, N. Articles by Guery, B.

Is Combination the Only Issue?

First of all, the patients were included if the treatment was started within the 24 h of the pneumonia diagnosis. It has been shown that a treatment during the first 8 h could dramatically improve survival (2). It is not clear from the data of these authors whether there could be a difference between the two groups with an earlier treatment in the bitherapy arm, partly explaining the observed difference.

Among the patients treated with combined therapy, 78.7% were mechanically ventilated. We cannot find in the paper a complete record of the bacteriological data and particularly the potential coinfections associated. The possible activity on these pathogens may also influence the results.

In the results section, the global mortality rate is 54.6%. The authors report 55.3% with monotherapy and 23.4% with combined therapy. With the same number of patients in each group and based on these two numbers, the overall mortality seems wrong.

From there, it seems difficult to agree with the conclusion that an association of antibiotics improves survival in pneumococcal illness. This study is observational and retrospective with many confounding factors. No explanation for the increased survival is provided. The potential consequences on antibiotic use and bacterial ecology could also be dangerous, particularly with the surprising survival with the use of glycopeptides. However, the most important information for clinical practice is that it is probably useless to continue a combined therapy after three days in pneumococcal-related infections.

Nicolas Boussekey, Karine Faure and Benoît Guery

Centre Hospitalier G. Chatiliez Tourcoing, France

FOOTNOTES

Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Baddour LM, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, Morris AJ, Luna CM, Snydman DR, Ko WC, et al. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 2004;170:440–444.[Abstract/Free Full Text]
2. Meehan TP, Fine MJ, Krumholz HM, Scinto JD, Galusha DH, Mockalis JT, Weber GF, Petrillo MK, Houck PM, Fine JM. Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA 1997;278:2080–2084.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Boussekey, N. Articles by Guery, B. Search for Related Content PubMed PubMed Citation Articles by Boussekey, N. Articles by Guery, B.