BMJ 1995;311:685 (9 September)

Letters

Oral versus intravenous antibiotics

Exclusion of sickest patients invalidates study

EDITOR,--Robert Chan and colleagues conclude that oral antibiotics are as efficacious as intravenous antibiotics in treating lower respiratory tract infections acquired in the community.1 Because of the design of their study, which excluded patients who were severely ill, any other conclusion would be surprising. Patients with lower respiratory tract infection and community acquired pneumonia are already treated at home with oral antibiotics by general practitioners, with a mortality of 0-3%.2 3 Furthermore, the British Thoracic Society's guidelines for community acquired pneumonia recommend oral antibiotics in moderate illness.4 It is therefore arguable whether there was ever any clinical need for intravenous antibiotics in Chan and colleagues' study. It follows that comparison between the three groups is clinically invalid. Many of their patients probably did not even require admission to hospital in view of the absence of radiological changes (58%) and severe illness.

I agree, however, that . . . [Full text of this article]


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Relevant Article

Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open, randomised controlled trial
Robert Chan, Linda Hemeryck, Myra O'Regan, Luke Clancy, and John Feely
BMJ 1995 310: 1360-1362. [Abstract] [Full Text]

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