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LETTERS: Mark Woodhead, M Mamun, T Rogers, and S J Wort Community acquired pneumonia in elderly people BMJ 1998; 317: 1524a [Full text]

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Elderly People and Atypical Pneumonia

Robin O Motz   (27 November 1998)

Elderly People and Atypical Pneumonia 27 November 1998
Robin O Motz, Assistant Professor of Clinical Medicine Columbia University College of Physicians and Surgeons Send response to journal: Re: Elderly People and Atypical Pneumonia	The letter of Woodward et. al. suggest that erythromycin not be added to the regime of elderly patients admitted with pneumonia, pending a comparison of cephalosporins with/without erythromycin. However,in all the papers that I have seen, when an organism has been isolated, show that 10 to 25 % of the organisms are atypicals: Chlamydia, Mycoplasma, or Legionella, and therefore the addition of a macrolide should always be considered. There may be regional variations (e.g. Legionella is very rare in Northern Manhattan). Now that IV azithromycin is available, which has much less GI toxicity than erythromycin, I feel that it should always be added to a cephalosporin, especially since there is no way to distinguish the atypicals clinically, beore culture. I also expect that as the use of pneumonoccal vaccine becomes more widespread among the elderly, the percentage of atypicals will rise. If price is a concern, then IV doxycycline, with its excellent coverage of Chlamydia and Mycoplasma could be used instead.