pneumonia

Not necessarily. In fact, an often-quoted study showed more relapses among patients with Pseudomonas aeruginosa nosocomial pneumonia treated for 8 days compared to 15 days, and concluded that the results did not apply to “non-fermenting gram negative bacilli” (1).

For methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, the data on the effectiveness of the shorter course therapy is also quite limited (1,2) . So for patients with pneumonia due to organisms such as P. aeruginosa or MRSA I decide on the duration of therapy on case-by-case basis depending on the overall stability of the patient and their progress in recovery.

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References

1. Chastre J, Wolff M, Fagon JY. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003;290:2588-98.

2. Rubinstein E, Kollef MH, Nathwani D. Pneumonia caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2008;46 (Suppl5):S378-385.

CRP level should drop to less than one-half of its value on admission after a couple of days of antibiotic therapy, since CRP half-life is less than a day following zero order elimination kinetics.

Of interest, in a study of serial CRP in severe CAP (1), a CRP ratio >0.5 by day 3 was associated with non-resolving pneumonia ( sensitivity 91%, specificity 55%) performing significantly better than body temperature or WBC count.

So if there is any doubt about how a patient is doing clinically, a repeat CRP looking for a drop of greater than on-half after 3-4 days of therapy may be helpful.

Bonus Pearl: Did you know that the half-life of CRP is 19 h?

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Reference

1. Coelho L, Povoa P, Almenda E, et al. Usefulness of C-reactive protein in monitoring the severe community-acquired pneumonia clinical course. Critical Care 2007;11:R92 https://ccforum.biomedcentral.com/articles/10.1186/cc6105

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Is the “8 day rule” for treatment of healthcare-associated pneumonia (HAP) appropriate irrespective of etiologic agent?

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How should follow-up serum C-reactive protein (CRP) in patients with community-acquired pneumonia (CAP) be interpreted?

CRP level should drop to less than one-half of its value on admission after a couple of days of antibiotic therapy, since CRP half-life is less than a day following zero order elimination kinetics.

Of interest, in a study of serial CRP in severe CAP (1), a CRP ratio >0.5 by day 3 was associated with non-resolving pneumonia ( sensitivity 91%, specificity 55%) performing significantly better than body temperature or WBC count.

So if there is any doubt about how a patient is doing clinically, a repeat CRP looking for a drop of greater than on-half after 3-4 days of therapy may be helpful.

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CRP level should drop to less than one-half of its value on admission after a couple of days of antibiotic therapy, since CRP half-life is less than a day following zero order elimination kinetics.

Of interest, in a study of serial CRP in severe CAP (1), a CRP ratio >0.5 by day 3 was associated with non-resolving pneumonia ( sensitivity 91%, specificity 55%) performing significantly better than body temperature or WBC count.

So if there is any doubt about how a patient is doing clinically, a repeat CRP looking for a drop of greater than on-half after 3-4 days of therapy may be helpful.

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Share this: Pearls4Peers

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