Letters

Community acquired pneumonia in elderly people

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7171.1524a (Published 28 November 1998) Cite this as: BMJ 1998;317:1524

Addition of erythromycin is not currently justified

  1. Mark Woodhead, Consultant in general and respiratory medicine
  1. Department of Respiratory Medicine, Manchester Royal Infirmary, Manchester M13 9WL
  2. University Hospital Aintree, Liverpool L9 7AL
  3. Department of Infectious Diseases, Imperial College School of Medicine, Hammersmith Hospital, London W12 0NN
  4. Department of Transplant Medicine, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Middlesex UB9 6JH

    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 …

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