Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
Owen et al. highlight the possibility that intra-venous antibiotics
may be over prescribed to patients with non-severe community acquired
pneumonia. The surviving sepsis campaign (SSC) guidelines for management
of severe sepsis and septic shock (as published in Crit Care Med 2004; 32:
858-873) recommend “intravenous antibiotic therapy should be started
within the first hour of recognition of severe sepsis, after appropriate
A quantity of the literature referenced by the SSC use the fulfilment
of two out of four of the systemic inflammatory response syndrome (SIRS)
criteria and a systolic BP less than 90mmHg as indicative of sepsis.
Given the difference between the SIRS and CURB criteria it is conceivable
that a patient apparently not deemed suitable for intra-venous antibiotic
treatment of pneumonia by the CURB criteria would be recommended for
aggressive treatment of sepsis (including central venous and arterial
access) by the SSC guidelines.
This apparent contradiction illustrates the continued importance of
overall clinical assessment in our increasingly guideline driven
management of patients.