Community acquired pneumonia in elderly people

BMJ 1998;317:1524 ( 28 November )

Letters

Community acquired pneumonia in elderly people

Addition of erythromycin is not currently justified

This pneumonia is only a small fraction of all hospital cases of chest infection and pneumonia

Authors' reply

Addition of erythromycin is not currently justified

The first 150 words of the full text of this article appear below.

EDITOR $---$ I agree with Wort and Rogers that current British guidelines on community acquired pneumonia need revision, but I donot believe that the addition of erythromycin should always beconsidered in elderly people.¹

They cite, as the basis for this recommendation, a study from Israel in which serological evidence of Chlamydia pneumoniaewas found in 26% of cases of community acquired pneumonia in elderlypeople.² It is not clear, in this or other similar studies,whether serological detection of C pneumoniae indicates the causeof the pneumonia or whether treatment directed against it willmake a clinical difference. More than one pathogen was identifiedin 30.4% (age 65-74) and 37.8% (age $>=$ 75) of cases, but furtherdetails are not given. In the original publication other pathogenswere also identified in the majority (69%) of cases in which Cpneumoniae was found (Streptococcus pneumoniae in 55%).³