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First-line antibiotics can fail almost a quarter of pneumonia patients


New research on the effectiveness of antibiotics for pneumonia patients suggests doctors may need to rethink their prescriptions, writes Andrew Masterson.


Almost a quarter of cases of community-acquired pneumonia may not be remedied by the first round of prescribed antibiotics.
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Nearly a quarter of Americans with community-acquired pneumonia – as opposed to hospital-acquired pneumonia – do not respond to first-line antibiotics, a disturbing new study has found.

The finding – uncovered by a team led by James McKinnell of LA BioMed in California – is cause for concern because pneumonia is the leading cause of death arising from infectious disease in the US.

McKinnell and colleagues examined the case histories of 251,947 adult patients who received outpatient treatment for pneumonia between 2011 and 2015.

Combing the records, they looked for cases that required a repeat antibiotic prescription, a change of antibiotic, a visit to an emergency room, or hospitalisation, within 30 days of diagnosis.

They found that a total of 22.1% of patients met the criteria for failing to respond to initial treatment. In patients treated with certain types of antibiotics – notably a class called beta-lactams – the failure rate actually topped 25%.

Patients over the age of 65 were heavily represented in the failure figures.

“The additional antibiotic therapy noted in the study increases the risk of antibiotic resistance and complications which are difficult to treat and may be life-threatening, especially for older adults,” comments McKinnell.

The study, presented at a recent conference and published in the American Journal of Respiratory and Critical Care Medicine, concludes that doctors should change their approach to treating at-risk pneumonia patients in the community.

“Our findings suggest that the community-acquired pneumonia treatment guidelines should be updated with more robust data on risk factors for clinical failure,” says McKinnell.

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Andrew Masterson is news editor of Cosmos.
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