Buiten het ziekenhuis opgelopen pneumonie; geen reden om huidige antibioticumrichtlijn te herzien

- Community-acquired pneumonia is an important cause of hospital admission and mortality in the adult population.

- The recommended antibiotic for pneumonia caused by Streptococcus pneumoniae is a β-lactam antibiotic and, for so-called atypical pathogens, a macrolide.

- In the US and elsewhere, the current recommendation is to start with a β-lactam antibiotic and a macrolide or with one of the new quinolones.

- The available literature consists largely of retrospective studies. Because of possible selection bias in these analyses and inconsistencies in reported outcomes, it is not possible to draw any well-founded conclusions from these studies.

- Reasons for a possible additional benefit of adding a macrolide to the therapy could include: a higher prevalence of undiagnosed atypical pathogens, the anti-inflammatory effects of macrolides, and resistance of the main pathogens against β-lactam antibiotics. None of these appear to play a significant role.

- There is no need to revise Dutch guidelines.