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Monotherapy versus combination antibiotic therapy for patients with bacteremic Streptococcus pneumoniae community-acquired pneumonia

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Abstract

The purpose of this study was to examine the impact of antimicrobial monotherapy vs combination therapy on length of stay and mortality for patients with Streptococcus pneumoniae pneumonia. Thirty-nine percent of patients received monotherapy, while 61% received combination therapy. Although there was no significant difference in mortality (OR 1.25, 95% CI = 0.25–6.8), there was a significant increase in length of stay for patients who received combination therapy (p = 0.02). Patients with bacteremic pneumococcal pneumonia treated with empiric combination therapy had no significant difference in mortality; however, they did have increased length of stay after adjusting for severity of illness. Randomized controlled trials are needed to determine what is the optimal empiric antimicrobial regime for patients with community-acquired pneumonia.

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Acknowledgments

Dr. Mortensen was supported by a Department of Veteran Affairs Veterans Integrated Service Network 17 new faculty grant and a Howard Hughes Medical Institute faculty start-up grant 00378-001. None of the authors, except for Drs. Anzueto, Restrepo, and Frei, have any conflicts of interest to disclose regarding this paper. Dr. Anzueto is currently a consultant with Pfizer, Ortho-McNeil, Sanofi-Aventis, Boehringer Ingelheim, GlaxoSmithKline, and Bayer Pharma. Dr. Anzueto has received research grants from Boehringer Ingelheim, GlaxoSmithKline, and C.R. Bard. Dr. Restrepo is a speaker for Pfizer, Wyeth and Elan Pharmaceuticals. Dr. Frei has received research grants from AstraZeneca and Elan Pharmaceuticals.

This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System. The views expressed in this article are those of the authors, and do not necessarily represent the views of the Department of Veterans Affairs.

All of the above research is in compliance with the laws of the United States of America.

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Authors and Affiliations

  1. Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78284, USA

    R. Chokshi, M. I. Restrepo, N. Weeratunge, C. R. Frei, A. Anzueto & E. M. Mortensen

  2. South Texas Veterans Health Care System, Audie L. Murphy VA hospital (11C6), 7400 Merton Minter Blvd, San Antonio, TX, 78230, USA

    M. I. Restrepo, A. Anzueto & E. M. Mortensen

Authors
  1. R. Chokshi
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  2. M. I. Restrepo
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  3. N. Weeratunge
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  4. C. R. Frei
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  5. A. Anzueto
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  6. E. M. Mortensen
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Correspondence to E. M. Mortensen.

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Chokshi, R., Restrepo, M.I., Weeratunge, N. et al. Monotherapy versus combination antibiotic therapy for patients with bacteremic Streptococcus pneumoniae community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 26, 447–451 (2007). https://doi.org/10.1007/s10096-007-0307-3

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