Community-acquired pneumonia: a comparison of clinical treatment failure in patients treated with either penicillin or cefuroxime
Ekloef and Schmidt Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine2012, 20(Suppl 2):P10http://www.sjtrem.com/content/20/S2/P10
Community-acquired pneumonia: a comparisonof clinical treatment failure in patients treatedwith either penicillin or cefuroximeJosefin Ekloef*, Thomas A Schmidt
From 4th Danish Emergency Medicine ConferenceRoskilde, Denmark. 25-26 November 2011
cefuroxime. Forty percent of the patients treated with
National and local guidelines in the Emergency depart-
penicillin experienced CTF compared to 17% in the
ment (ED) at Holbaek hospital recommend penicillin as
group treated with cefuroxime (p=0.347). Patients were
first-line treatment of community-acquired pneumonia
followed for 9 days. At 5 days, a survival rate without
(CAP). Nevertheless, the use of cefuroxime seem to be
CTF was estimated to 0,75 for cefuroxime and 0.54 for
substantial when admitting patients with CAP.
penicillin. There was no significant difference between
The aim of this study was to document the use of
the treatment groups (logrank test: p=0.227). No further
penicillin and cefuroxime as initial treatment of CAP,
and to compare clinical treatment failure (CTF) in thetwo groups.
ConclusionCefuroxime was the most common choice of treatment
for CAP. Thus, treatment of CAP at Holbaek hospital
Data was collected by finding medical records of
does not adhere to national or local guidelines. How-
patients discharged from Holbaek hospital with a princi-
ever, numerically the results may indicate a higher rate
pal diagnosis of CAP in the period January-March 2010.
of CTF in patients treated with penicillin compared to
A total number of 50 patients were assessed. Patients <
cefuroxime. This need not to be a mere play of chance.
18 years (n=0), with chronic obstructive pulmonary dis-
A prospective study with a higher number of observa-
ease (COPD) (n=17), in immune-suppressive treatment
(n=4), and receiving other antibiotic as mono therapy(n=2) or as combination therapy (n=5) were excluded.
CTF was defined as change of therapy due to unre-
sponsiveness. Kaplan-Meier plot was used to estimatetime until CTF (e.g. end-point) and probability of CTFbetween the groups. Time to CTF was defined as days
Cite this article as: Ekloef and Schmidt: Community-acquired
from initial therapy to change. Patients dying (n=2) or
pneumonia: a comparison of clinical treatment failure in patients
being discharged without CTF (n=14) were censored at
treated with either penicillin or cefuroxime. Scandinavian Journal ofTrauma, Resuscitation and Emergency Medicine 2012 20(Suppl 2):P10.
ResultsAll patients were treated with antibiotics intravenously.
Treatment was initiated in the ED in 77% of the cases.
Fifty-five percent of all patients were treated with
* Correspondence: Department of Emergency Medicine, Holbaek Hospital, Denmark
2012 Ekloef and Schmidt; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License ), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.
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