The etiology of community-acquired pneumonia in Australia

Why penicillin plus doxycycline or a macrolide is the most appropriate therapy

Patrick G P Charles, Michael Whitby, Andrew J. Fuller, Robert Stirling, Alistair A. Wright, Tony M. Korman, Peter W. Holmes, Keryn J. Christiansen, Grant W. Waterer, Robert J. P. Pierce, Barrie C. Mayall, John G. Armstrong, Michael G. Catton, Graeme R. Nimmo, Barbara Johnson, Michelle Hooy, M. L. Grayson, Australian CAP Study Collaboration

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147 Citations (Scopus)

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 narrowerspectrum 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. Members of the study group are listed at the end of the text.

Original languageEnglish
Pages (from-to)1513-1521
Number of pages9
JournalClinical Infectious Diseases
Volume46
Issue number10
DOIs
Publication statusPublished - 15 May 2008

Cite this

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. / The etiology of community-acquired pneumonia in Australia : Why penicillin plus doxycycline or a macrolide is the most appropriate therapy. In: Clinical Infectious Diseases. 2008 ; Vol. 46, No. 10. pp. 1513-1521.
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title = "The etiology of community-acquired pneumonia in Australia: Why penicillin plus doxycycline or a macrolide is the most appropriate therapy",
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 narrowerspectrum 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. Members of the study group are listed at the end of the text.",
author = "Charles, {Patrick G P} and Michael Whitby and Fuller, {Andrew J.} and Robert Stirling and Wright, {Alistair A.} and Korman, {Tony M.} and Holmes, {Peter W.} and Christiansen, {Keryn J.} and Waterer, {Grant W.} and Pierce, {Robert J. P.} and Mayall, {Barrie C.} and Armstrong, {John G.} and Catton, {Michael G.} and Nimmo, {Graeme R.} and Barbara Johnson and Michelle Hooy and Grayson, {M. L.} and {Australian CAP Study Collaboration} and Paul Johnson and Wendy Munckhof and David Looke and Luke Garske and Geoffrey Playford and Denis Spelman and Tom Kotsimbos and Peter Holmes and Tony Korman and Philip Bardin and Christopher Heath and Christopher Birch and Julian Druce and Norbert Ryan and Lou Irving and David Hart",
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Charles, PGP, Whitby, M, Fuller, AJ, Stirling, R, Wright, AA, Korman, TM, Holmes, PW, Christiansen, KJ, Waterer, GW, Pierce, RJP, Mayall, BC, Armstrong, JG, Catton, MG, Nimmo, GR, Johnson, B, Hooy, M, Grayson, ML & 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, vol. 46, no. 10, pp. 1513-1521. https://doi.org/10.1086/586749

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.; Australian CAP Study Collaboration.

In: Clinical Infectious Diseases, Vol. 46, No. 10, 15.05.2008, p. 1513-1521.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The etiology of community-acquired pneumonia in Australia

T2 - Why penicillin plus doxycycline or a macrolide is the most appropriate therapy

AU - Charles, Patrick G P

AU - Whitby, Michael

AU - Fuller, Andrew J.

AU - Stirling, Robert

AU - Wright, Alistair A.

AU - Korman, Tony M.

AU - Holmes, Peter W.

AU - Christiansen, Keryn J.

AU - Waterer, Grant W.

AU - Pierce, Robert J. P.

AU - Mayall, Barrie C.

AU - Armstrong, John G.

AU - Catton, Michael G.

AU - Nimmo, Graeme R.

AU - Johnson, Barbara

AU - Hooy, Michelle

AU - Grayson, M. L.

AU - Australian CAP Study Collaboration

AU - Johnson, Paul

AU - Munckhof, Wendy

AU - Looke, David

AU - Garske, Luke

AU - Playford, Geoffrey

AU - Spelman, Denis

AU - Kotsimbos, Tom

AU - Holmes, Peter

AU - Korman, Tony

AU - Bardin, Philip

AU - Heath, Christopher

AU - Birch, Christopher

AU - Druce, Julian

AU - Ryan, Norbert

AU - Irving, Lou

AU - Hart, David

PY - 2008/5/15

Y1 - 2008/5/15

N2 - 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 narrowerspectrum 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. Members of the study group are listed at the end of the text.

AB - 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 narrowerspectrum 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. Members of the study group are listed at the end of the text.

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JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

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