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Treatment of pneumonia in patients at risk of infection with gram-negative bacilli

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      Abstract

      Patients with a history of chronic debilitating disease due to a variety of causes are known to be at risk for infection with coliform gram-negative bacilli when they present with community-acquired pneumonia. Empiric treatment with broad-spectrum parenteral antibiotics is often begun in such patients pending the result of blood and other cultures. The optimal duration of broad-spectrum empiric therapy in such patients when cultures fail to reveal a specific pathogen is unknown. Review was made of the charts of 131 patients with community-acquired pneumonia admitted to the hospital and treated with broad-spectrum parenteral antibiotics in whom a specific pathogen was never isolated. Overall, 89 percent of these patients were cured without complication or relapse. Patients receiving broad-spectrum therapy for four days or less due to rapid clinical improvement had a successful outcome in 95 percent of cases. It is concluded that broad-spectrum parenteral antibiotic therapy can safely be abbreviated provided response to therapy is prompt.
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      References

        • Pierce AK
        • Sanford JP
        Aerobic gram-negative bacillary pneumonias.
        Am Rev Respir Dis. 1974; 110: 647-658
        • Tillotson JR
        • Lerner AM
        Pneumonias caused by gram negative bacilli.
        Medicine (Baltimore). 1966; 45: 65-76
        • Valdivieso M
        • Gil-Extremera B
        • Zornoza J
        • et al.
        Gram-negative bacillary pneumonia in the compromised host.
        Medicine (Baltimore). 1977; 56: 241-254
        • Pennington JE
        Community-acquired pneumonia and acute bronchitis.
        in: Pennington JE Respiratory infections: diagnosis and management. Raven Press, New York1983: 125-134
        • Crane LR
        • Lerner AM
        Gram-negative bacillary pneumonias.
        in: Pennington JE Respiratory infections: diagnosis and management. Raven Press, New York1983: 227-250
        • Van Metre TE
        Pneumococcus pneumonia treated with antibiotics: the prognostic significance of certain clinical findings.
        N Engl J Med. 1954; 251: 1048-1052
        • Guzzetta P
        • Toews GB
        • Robertson KJ
        • Pierce AK
        Rapid diagnosis of community-acquired bacterial pneumonia.
        Am Rev Respir Dis. 1983; 128: 461-464
        • Sullivan RJ
        • Dowdle WR
        • Marine WM
        • Hierholzer JC
        Adult pneumonia in a general hospital: etiology and host factors.
        Arch Intern Med. 1972; 129: 935-942
        • Valenti WM
        • Trudell RG
        • Bentley DW
        Factors predisposing to oropharyngeal colonization with gram-negative bacillin in the aged.
        N Engl J Med. 1978; 298: 1108-1111
        • Ebright JR
        • Rytel MW
        Bacterial pneumonia in the elderly.
        J Am Geriatr Soc. 1980; 28: 220-223
        • Johanson WG
        • Pierce AK
        • Sanford JP
        Changing pharyngeal bacterial flora of hospitalized patients: emergence of gram-negative bacilli.
        N Engl J Med. 1969; 281: 1137-1140
        • Johanson WG
        • Pierce AK
        • Sanford JP
        • Thomas GD
        Nosocomial respiratory infections with gram-negative bacilli: the significance of colonization of the respiratory tract.
        Ann Intern Med. 1972; 77: 701-706
        • Huxley EJ
        • Viroslav J
        • Gray WR
        • Pierce AK
        Pharyngeal aspiration in normal adults and patients with depressed consciousness.
        Am J Med. 1978; 64: 564-568
        • Mackowiak PA
        • Martin RM
        • Jones SR
        • Smith JW
        Pharyngeal colonization by gram-negative bacilli in aspiration-prone persons.
        Arch Intern Med. 1978; 138: 1224-1227
        • Mackowiak PA
        • Martin RM
        • Smith JW
        The role of bacterial interference in the increased prevalence of oropharyngeal gram-negative bacilli among alcoholics and diabetics.
        Am Rev Respir Dis. 1979; 120: 589-593
        • Dal Nogare AR
        • Toews GB
        • Pierce AK
        Increased salivary elastase precedes gram-negative bacillary colonization in postoperative patients.
        Am Rev Respir Dis. 1987; 135: 671-675
        • Stockley RA
        • Burnett D
        Alpha-1-antitrypsin and leukocyte elastase in infected and noninfected sputum.
        Am Rev Respir Dis. 1979; 120: 1081-1086
        • Fiala M
        A study of the combined role of viruses, mycoplasmas and bacteria in adult pneumonia.
        Am J Med Sci. 1969; 257: 44-51
        • Dorff GJ
        • Rytel MW
        • Farner SG
        • Scanlon G
        Etiologies and characteristic features of pneumonias in a municipal hospital.
        Am J Med Sci. 1973; 266: 349-358