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Original Research: 75 Seminal Studies, 1935–2009 |

Introduction: Pneumonia

Glenn S. Tillotson, PhD, FCCP
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


Copyright © 2009 American College of Chest Physicians


Chest. 2009;136(5_suppl):e20-e21. doi:10.1378/chest.09-2264
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The treatment of bacterial pneumonia acquired in the community has posed major clinical challenges. Even with the introduction of penicillin in the early 1940s, it was clear that optimal therapy was still elusive. The effective management of “the old man's friend” was still actively being sought. Although Austrian and Gold,1 in their seminal 1964 paper, demonstrated the benefits of antibiotic therapy as compared with no antibiotic or serum therapy several years earlier, Volini and colleagues2 from Chicago sought to identify the best regimen from the agents available. This group from Cook County Hospital compared sulfadiazine with penicillin with a combination of the two drugs. The rationale behind this study was that mortality rates for community-acquired pneumonia (CAP) treated with sulfathiazole was 12.7% compared with 11.1% with parenteral penicillin, while Collen et al3 reported a 6.7% mortality with a combination of the two drugs. Volini and colleagues2 evaluated four regimens: sulfadiazine alone, penicillin given intramuscularly, oral penicillin, and a combination of penicillin and sulfadiazine. Almost 250 patients were evaluated across the four cohorts. They examined mortality rates, adverse events, duration of therapy, and effect of therapy on vital signs. They observed that penicillin was superior to sulfadiazine, that the combination was not more effective and, indeed, was probably antagonistic. Interestingly, they noted that the average duration of therapy was 5.5 to 7.7 days, thus bringing into question why we “drifted” toward 14-day courses of antibiotics for CAP?

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