When to Switch Therapy in Patients with Severe Community-Acquired Pneumonia
Authors: Eric M. Mortensen, Marcos I. Restrepo, Antonio Anzueto
Journal: Annals of Internal Medicine (2008)

Letters15 April 2008When to Switch Therapy in Patients with Severe Community-Acquired PneumoniaEric M. Mortensen, MD, MSc, Marcos I. Restrepo, MD, MSc, and Antonio Anzueto, MDEric M. Mortensen, MD, MScFrom South Texas Veterans Health Care System, San Antonio, TX 78229.Search for more papers by this author, Marcos I. Restrepo, MD, MScFrom South Texas Veterans Health Care System, San Antonio, TX 78229.Search for more papers by this author, and Antonio Anzueto, MDFrom South Texas Veterans Health Care System, San Antonio, TX 78229.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-8-200804150-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read with great interest the recent Update in Hospital Medicine by Amin and Pistoria (1). However, this summary overplayed the strength of the article by Oosterheert and colleagues (2), and we disagree with the recommendations. Oosterheert and colleagues' article (2) was a ground-breaking, randomized, controlled trial that examined 2 strategies of conversion from intravenous to oral antimicrobial therapy in patients hospitalized with community-acquired pneumonia. Unfortunately, this article had several limitations, such as lack of a true cohort of participants with severe pneumonia—the overall 28-day mortality rate was 5% versus the generally accepted rate of 20% to ...References1. Amin AN, Pistoria MJ. Update in hospital medicine. Ann Intern Med. 2007;147:628-32. [PMID: 17975185] LinkGoogle Scholar2. Oosterheert JJ, Bonten MJ, Schneider MM, Buskens E, Lammers JW, Hustinx WM, et al. Effectiveness of early switch from intravenous to oral antibiotics in severe community acquired pneumonia: multicentre randomised trial. BMJ. 2006;333:1193. [PMID: 17090560] CrossrefMedlineGoogle Scholar3. Angus DC, Marrie TJ, Obrosky DS, Clermont G, Dremsizov TT, Coley C, et al. Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society Diagnostic criteria. Am J Respir Crit Care Med. 2002;166:717-23. [PMID: 12204871] CrossrefMedlineGoogle Scholar4. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2 S27-72. [PMID: 17278083] CrossrefMedlineGoogle Scholar5. Mortensen EM, Restrepo M, Anzueto A, Pugh J. Effects of guideline-concordant antimicrobial therapy on mortality among patients with community-acquired pneumonia. Am J Med. 2004;117:726-31. [PMID: 15541321] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Eric M. Mortensen, MD, MSc; Marcos I. Restrepo, MD, MSc; Antonio Anzueto, MDAffiliations: From South Texas Veterans Health Care System, San Antonio, TX 78229.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUpdate in Hospital Medicine Alpesh N. Amin and Michael J. Pistoria When to Switch Therapy in Patients with Severe Community-Acquired Pneumonia Alpesh N. Amin and Michael J. Pistoria Metrics 15 April 2008Volume 148, Issue 8Page: 625KeywordsAntibiotic resistanceAntibioticsAntimicrobialsDeath ratesIntensive care unitsIntubationPharmacokineticsPneumoniaTreatment guidelines ePublished: 15 April 2008 Issue Published: 15 April 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...