torres.qxp 7/8/09 4:14 pm Page 64
Pneumonia
micro-organism is not susceptible, another β-lactam, possibly a the cases of pneumonia produced by non-fermenting Gram-
carbapenem, may have to be substituted. negative bacilli, the ability to eradicate the micro-organism of the
• Empirical antibiotic treatment active against MRSA should be bronchial secretion was lower with the shorter regimen. In contrast,
withdrawn if its presence is not confirmed in cultures. the 14-day treatment regimen was associated with a greater trend
• Discontinuation of the fluoroquinolone and especially the towards colonisation by multiresistant flora and a greater frequency
aminoglycoside should be considered after three to five days of of re-infection.
85
treatment. The bactericidal activity of aminoglycosides and
fluoroquinolones leads to a rapid reduction in the bacterial In patients with clinical suspicion of ICU pneumonia who have
load during the first days of treatment. After this time, a clinical pulmonary infection score lower than six on the third
monotherapy may be sufficient. This approach would decrease the day of treatment, the treatment may be withdrawn. In this
emergence of resistant mutants and minimise nephrotoxicity for setting, the patient probably did not have pneumonia or the
the aminoglycoside. pneumonia was sufficiently mild that prolonged antibiotic
treatment was not required.
86
■
Duration of Infection
Most infections can be cured with regimens of five to seven days.
Miquel Ferrer is a Consultant Physician in the Respiratory
Four situations may justify more prolonged treatment:
Intensive and Intermediate Care Unit, Pulmonology and
Allergy Service at the Hospital Clínic of Barcelona. He is
• infection by micro-organisms that may multiply in the cellular
also a Senior Researcher at the Institute of Biomedical
Research ‘August Pi i Sunyer’, University of Barcelona,
cytoplasm (Legionella spp);
and at the Network of Biomedical Research Centres in
• the presence of biofilms or prosthetic devices; Respiratory Diseases of the Institute of Health Carlos III,
• the development of tissue necrosis, the formation of abscesses
Spanish Ministry of Science and Technology. He has
participated as an expert in several advisory boards and
or infection within a closed cavity (empyema); and
scientific forums in the fields of hospital-acquired pneumonia, non-invasive ventilation,
• the persistence of the original infection (perforation or weaning from mechanical ventilation and intermediate respiratory care units.
endocarditis, etc.). If the course is favourable, as defined by
defervescence, and there is improvement in the ratio of arterial
Antoni Torres is Head of Pulmonology and Allergy at the
Hospital Clínic of Barcelona and a Senior Consultant and
oxygen tension to inspired oxygen fraction and a reduction in
Professor of Pulmonology in the Department of
the C-reactive protein (CRP) within the first three to five days
Medicine at the University of Barcelona. Professor Torres
of treatment, treatment may be withdrawn after the completion
is the co-ordinator of the research group ‘Management
and Prevention of Respiratory Infections’ at the Institute
of seven days. If the causative micro-organism is a non-
of Biomedical Research ‘August Pi i Sunyer’, and has
fermenting Gram-negative bacilli, treatment can be extended
participated as an expert on most of the international
beyond 14 days.
guidelines for community-acquired and hospital-aquired
pneumonia. He won the award granted by the Fundación de Ciencias de la Salud for
the 10 best biomedical researchers during the last four years in Spain, and in 2007 he
In one study comparing the efficacy of a seven-day schedule versus
received the Lilly Foundation’s award in biomedical and clinical research.
a 14-day schedule in the treatment of VAP, it was observed that in
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64 EUROPEAN RESPIRATORY DISEASE
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