Addition of erythromycin is not currently justified

EDITOR—I agree with Wort and Rogers that current British guidelines on community acquired pneumonia need revision, but I do not believe that the addition of erythromycin should always be considered in elderly people.1

They cite, as the basis for this recommendation, a study from Israel in which serological evidence of Chlamydia pneumoniae was found in 26% of cases of community acquired pneumonia in elderly people.2 It is not clear, in this or other similar studies, whether serological detection of C pneumoniae indicates the cause of the pneumonia or whether treatment directed against it will make a clinical difference. More than one pathogen was identified in 30.4% (age 65-74) and 37.8% (age 75) of cases, but further details are not given. In the original publication other pathogens were also identified in the majority (69%) of cases in which C pneumoniae was found (Streptococcus pneumoniae in 55%).3

A high frequency of copathogens has been found in similar studies, suggesting that C pneumoniae may simply initiate events while the other pathogen causes the pneumonia. Treatment with antibiotics to which C pneumoniae is not sensitive leads to clinical recovery as quickly as when agents to which it is sensitive are given,4 supporting this viewpoint. A recent North American study, which included elderly patients, argued that there is no place for routine use of macrolides since only 7.5% of patients were found to have an organism that merited macrolide treatment …