The etiology of community-acquired pneumonia in Australia: Why penicillin plus doxycycline or a macrolide is the most appropriate therapy

Charles, Patrick G. P., Whitby, Michael, Fuller, Andrew J., Stirling, Robert, Wright, Alistair A., Korman, Tony M., Holmes, Peter W., Christiansen, Keryn J., Waterer, Grant W., Pierce, Robert J. P., Mayall, Barrie C., Armstrong, John G., Catton, Michael G., Nimmo, Graeme R., Johnson, Barbara, Hooy, Michelle, Grayson, M. L. and Australian CAP Study Collaboration (2008) The etiology of community-acquired pneumonia in Australia: Why penicillin plus doxycycline or a macrolide is the most appropriate therapy. Clinical Infectious Diseases, 46 10: 1513-1521. doi:10.1086/586749

Author Charles, Patrick G. P.
Whitby, Michael
Fuller, Andrew J.
Stirling, Robert
Wright, Alistair A.
Korman, Tony M.
Holmes, Peter W.
Christiansen, Keryn J.
Waterer, Grant W.
Pierce, Robert J. P.
Mayall, Barrie C.
Armstrong, John G.
Catton, Michael G.
Nimmo, Graeme R.
Johnson, Barbara
Hooy, Michelle
Grayson, M. L.
Australian CAP Study Collaboration
Title The etiology of community-acquired pneumonia in Australia: Why penicillin plus doxycycline or a macrolide is the most appropriate therapy
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
Publication date 2008-05-15
Year available 2008
Sub-type Article (original research)
DOI 10.1086/586749
Volume 46
Issue 10
Start page 1513
End page 1521
Total pages 9
Editor S. L. Gorbach
Place of publication Chicago, I.L., U.S.A.
Publisher Chicago University Press
Collection year 2009
Language eng
Subject C1
110309 Infectious Diseases
Formatted abstract

Background.Available data on the etiology of community‐acquired pneumonia (CAP) in Australia are very limited. Local treatment guidelines promote the use of combination therapy with agents such as penicillin or amoxycillin combined with either doxycycline or a macrolide.

Methods.The Australian CAP Study (ACAPS) was a prospective, multicenter study of 885 episodes of CAP in which all patients underwent detailed assessment for bacterial and viral pathogens (cultures, urinary antigen testing, serological methods, and polymerase chain reaction). Antibiotic agents and relevant clinical outcomes were recorded.

Results.The etiology was identified in 404 (45.6%) of 885 episodes, with the most frequent causes being Streptococcus pneumoniae (14%), Mycoplasma pneumoniae (9%), and respiratory viruses (15%; influenza, picornavirus, respiratory syncytial virus, parainfluenza virus, and adenovirus). Antibiotic‐resistant pathogens were rare: only 5.4% of patients had an infection for which therapy with penicillin plus doxycycline would potentially fail. Concordance with local antibiotic recommendations was high (82.4%), with the most commonly prescribed regimens being a penicillin plus either doxycycline or a macrolide (55.8%) or ceftriaxone plus either doxycycline or a macrolide (36.8%). The 30‐day mortality rate was 5.6% (50 of 885 episodes), and mechanical ventilation or vasopressor support were required in 94 episodes (10.6%). Outcomes were not compromised by receipt of narrower‐spectrum β‐lactams, and they did not differ on the basis of whether a pathogen was identified.

Conclusions.The vast majority of patients with CAP can be treated successfully with narrow‐spectrum β‐lactam treatment, such as penicillin combined with doxycycline or a macrolide. Greater use of such therapy could potentially reduce the emergence of antibiotic resistance among common bacterial pathogens.

Q-Index Code C1
Q-Index Status Confirmed Code
Additional Notes no.1513. electronically published 4 April 2008

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2009 Higher Education Research Data Collection
Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 92 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 24 Mar 2009, 14:57:18 EST by Brenda Mason on behalf of UQ Centre for Clinical Research