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Cefuroxime for empiric treatment of community-acquired pneumococcal pneumonia: is there a generation gap?
Chemotherapy. 2009; 55(2):97-104.C

Abstract

BACKGROUND

Streptococcus pneumoniae infection is an important cause of morbidity and mortality. The recommendations to use expanded-spectrum beta-lactam drugs for patients with community-acquired pneumonia derived from the growing prevalence of penicillin-resistant pneumococci. Controversy exists regarding the use of second generation cephalosporins for empirical treatment of community-acquired pneumonia.

METHODS

In a retrospective study, 31 adult patients with pneumococcal pneumonia and bacteremia caused by S. pneumoniae that was intermediately resistant to penicillin were compared with 31 control patients with similar infection caused by penicillin-susceptible pneumococci. All patients were treated empirically with cefuroxime, alone or in combination with other antibiotics. Morbidity and mortality were studied.

RESULTS

All unsusceptible pneumococci isolates were intermediately resistant to penicillin. No cases of fully resistant pneumococci were isolated from blood cultures in our hospital. Two factors were significantly associated with non-susceptibility to penicillin: hematologic malignancy and immunosuppression. No significant difference in morbidity or mortality was detected between the 2 groups, and penicillin minimum inhibitory concentration was not found to be a factor associated with mortality.

CONCLUSIONS

Patients with pneumococcal pneumonia caused by intermediately resistant pneumococci can be empirically treated with cefuroxime. In regions where fully resistant pneumococci are rare, the use of a second generation cephalosporin for empiric treatment of community-acquired pneumonia may be appropriate.

Authors+Show Affiliations

Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19145079

Citation

Wiener-Well, Yonit, et al. "Cefuroxime for Empiric Treatment of Community-acquired Pneumococcal Pneumonia: Is There a Generation Gap?" Chemotherapy, vol. 55, no. 2, 2009, pp. 97-104.
Wiener-Well Y, Raveh D, Schlesinger Y, et al. Cefuroxime for empiric treatment of community-acquired pneumococcal pneumonia: is there a generation gap? Chemotherapy. 2009;55(2):97-104.
Wiener-Well, Y., Raveh, D., Schlesinger, Y., Yinnon, A. M., & Rudensky, B. (2009). Cefuroxime for empiric treatment of community-acquired pneumococcal pneumonia: is there a generation gap? Chemotherapy, 55(2), 97-104. https://doi.org/10.1159/000192393
Wiener-Well Y, et al. Cefuroxime for Empiric Treatment of Community-acquired Pneumococcal Pneumonia: Is There a Generation Gap. Chemotherapy. 2009;55(2):97-104. PubMed PMID: 19145079.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cefuroxime for empiric treatment of community-acquired pneumococcal pneumonia: is there a generation gap? AU - Wiener-Well,Yonit, AU - Raveh,David, AU - Schlesinger,Yechiel, AU - Yinnon,Amos M, AU - Rudensky,Bernard, Y1 - 2009/01/15/ PY - 2008/02/05/received PY - 2008/11/04/accepted PY - 2009/1/16/entrez PY - 2009/1/16/pubmed PY - 2009/3/26/medline SP - 97 EP - 104 JF - Chemotherapy JO - Chemotherapy VL - 55 IS - 2 N2 - BACKGROUND: Streptococcus pneumoniae infection is an important cause of morbidity and mortality. The recommendations to use expanded-spectrum beta-lactam drugs for patients with community-acquired pneumonia derived from the growing prevalence of penicillin-resistant pneumococci. Controversy exists regarding the use of second generation cephalosporins for empirical treatment of community-acquired pneumonia. METHODS: In a retrospective study, 31 adult patients with pneumococcal pneumonia and bacteremia caused by S. pneumoniae that was intermediately resistant to penicillin were compared with 31 control patients with similar infection caused by penicillin-susceptible pneumococci. All patients were treated empirically with cefuroxime, alone or in combination with other antibiotics. Morbidity and mortality were studied. RESULTS: All unsusceptible pneumococci isolates were intermediately resistant to penicillin. No cases of fully resistant pneumococci were isolated from blood cultures in our hospital. Two factors were significantly associated with non-susceptibility to penicillin: hematologic malignancy and immunosuppression. No significant difference in morbidity or mortality was detected between the 2 groups, and penicillin minimum inhibitory concentration was not found to be a factor associated with mortality. CONCLUSIONS: Patients with pneumococcal pneumonia caused by intermediately resistant pneumococci can be empirically treated with cefuroxime. In regions where fully resistant pneumococci are rare, the use of a second generation cephalosporin for empiric treatment of community-acquired pneumonia may be appropriate. SN - 1421-9794 UR - https://www.unboundmedicine.com/medline/citation/19145079/Cefuroxime_for_empiric_treatment_of_community_acquired_pneumococcal_pneumonia:_is_there_a_generation_gap L2 - https://www.karger.com?DOI=10.1159/000192393 DB - PRIME DP - Unbound Medicine ER -