Associations between empirical antimicrobial therapy at the hospital and mortality in patients with severe community-acquired pneumonia

Intensive Care Med. 2002 Aug;28(8):1030-5. doi: 10.1007/s00134-002-1325-3. Epub 2002 Apr 25.


Introduction: The aim of the study was to examine different antibiotic choices and their relation to outcomes.

Methods: We reviewed patients with severe community-acquired pneumonia (SCAP) from two multicenter studies. Empirical antimicrobial regimens were classified as: macrolides alone (group M); macrolides plus betalactams (group MB); macrolides plus betalactam/betalactamase inhibitor (group MBI); every regimen including aminoglycosides (group A); non-pseudomonal third-generation cephalosporins alone (group C); another betalactam alone (first- and second-generation cephalosporins, or betalactam/betalactamase inhibitor) (group B); fluoroquinolones (group F); and other regimens (group Misc).

Results: Initial distribution of regimens was: group MB: 261 patients; group A: 65 patients; group C: 31 patients; group B: 23 patients; group M: 18 patients; group MBI: 13 patients; group F: 11 patients; group Misc: 38 patients. The lowest overall mortality was associated with initial treatment with a macrolide plus other agent (or alone). No deaths were documented among the 13 patients receiving amoxicillin/clavulanate plus a macrolide. The excess mortality for initial treatment with group A was significantly higher (14.2%; CI 95% 27.3-1.1) than the overall mortality rate between patients receiving a macrolide plus other agents. No significant differences were documented when mortality was adjusted for intubated patients.

Conclusion: Clinicians select the empirical antibiotic regimen after classifying patients according to likely pathogens and prognosis. The inclusion of a macrolide as part of the initial therapeutic regimen for SCAP appears to be as safe and effective as alternative options. Addition of a macrolide agent to a betalactam/betalactamase inhibitor or using a macrolide alone was a marker for less severe disease.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Clinical Protocols
  • Community-Acquired Infections / drug therapy*
  • Community-Acquired Infections / mortality
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Intensive Care Units / standards*
  • Lactams
  • Macrolides
  • Male
  • Pneumonia, Bacterial / drug therapy*
  • Pneumonia, Bacterial / mortality
  • Retrospective Studies
  • Spain / epidemiology


  • Anti-Bacterial Agents
  • Lactams
  • Macrolides