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Editorials |

Monotherapy in Severe Community-Acquired Pneumonia: Is It Worthy?

Antoni Torres, MD, FCCP
Author and Funding Information

Affiliations: Barcelona, Spain
 ,  Dr. Torres is Chief of the Pulmonology Department, Hospital Clinic, IDIBAPS, Facultat de Medicina, Universitat de Barcelona.

Correspondence to: Antoni Torres, MD, FCCP, Servei de Pneumologia i Allergia Respiratoria, Hospital Clinic, Villaroel 180, 08036 Barcelona, Spain; e-mail: atorres@ub.edu



Chest. 2005;128(1):10-13. doi:10.1378/chest.128.1.10
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1Alvarez-Lerma, F, Torres, A (2004) Severe community-acquired pneumonia.Curr Opin Crit Care10,369-3742Ruiz, M, Ewig, S, Torres, A, et al Severe community-acquired pneumonia: risk factors and follow-up epidemiology.Am J Respir Crit Care Med1999;160,923-9293Ewig, S, Ruiz, M, Mensa, J, et al Severe community-acquired pneumonia: assessment of severity criteria.Am J Respir Crit Care Med1998;158,1102-11084Ewig, S, de Roux, A, Bauer, T, et al Validation of predictive rules and indices of severity for community acquired pneumonia.Thorax2004;59,421-4275Angus, DC, Marrie, TJ, Obrosky, DS, et al Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society Diagnostic criteria.Am J Respir Crit Care Med2002;166,717-7236de Castro, FR, Torres, A Optimizing treatment outcomes in severe community-acquired pneumonia.Am J Respir Med2003;2,39-547Ewig, S, Schafer, H, Torres, A Severity assessment in community-acquired pneumonia.Eur Respir J2000;16,1193-12018Halm, EA, Fine, MJ, Marrie, TJ, et al Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines.JAMA1998;279,1452-14579Houck, PM, Bratzler, DW, Nsa, W, et al Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia.Arch Intern Med2004;164,637-64410Fernandez-Sabe, N, Carratala, J, Roson, B, et al Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes.Medicine (Baltimore)2003;82,159-16911Arancibia, F, Bauer, TT, Ewig, S, et al Community-acquired pneumonia due to Gram-negative bacteria andPseudomonas aeruginosa: incidence, risk, and prognosis.Arch Intern Med2002;162,1849-185812Cordero, E, Pachon, J, Rivero, A, et al Community-acquired bacterial pneumonia in human immunodeficiency virus-infected patients: validation of severity criteria; Grupo Andaluz para el Estudio de las Enfermedades Infecciosas.Am J Respir Crit Care Med2000;162,2063-206813Bonten, M, Chastre, J, Craig, W, et al HAP Guidelines.Am J Respir Crit Care Med2005;171,388-41614Mandell, LA, Bartlett, JG, Dowell, SF, et al Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults.Clin Infect Dis2003;37,1405-143315Niederman, MS, Mandell, LA, Anzueto, A, et al Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and preventionAm J Respir Crit Care Med2001;163,1730-175416British Thoracic Society Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults.Thorax2001;56(Suppl),IV1-IV6417Finch, R, Schurmann, D, Collins, O, et al Randomized controlled trial of sequential intravenous (i.v.) and oral moxifloxacin compared with sequential i.v. and oral co-amoxiclav with or without clarithromycin in patients with community-acquired pneumonia requiring initial parenteral treatment.Antimicrob Agents Chemother2002;46,1746-175418Menendez, R, Torres, A, Zalacain, R, et al Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome.Thorax2004;59,960-96519Waterer, GW, Somes, GW, Wunderink, RG Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia.Arch Intern Med2001;161,1837-184220Martinez, JA, Horcajada, JP, Almela, M, et al Addition of a macrolide to a β-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia.Clin Infect Dis2003;36,389-39521Macrolides as biologic response modifiers: immunomodulatory and anti-inflammatory effects.Chest2004;125(Suppl),415-78522Baddour, LM, Yu, VL, Klugman, KP, et al Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia.Am J Respir Crit Care Med2004;170,440-444723Fogarty, C, Siami, G, Kohler, R, et al Multicenter, open-label, randomised study to compare the safety and efficacy of levofloxacin versus ceftriaxone sodium and erythromycin followed by clarithromycin and amoxicillin-clavulanate in the treatment of serious community-acquired pneumonia in adults.Clin Infect Dis2004;38,S16-S23

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