Individualizing duration of antibiotic therapy in community-acquired pneumonia.

International experts suggest tailoring antibiotic duration in community-acquired pneumonia (CAP) according to patients' characteristics. We aimed to assess the effectiveness of an individualized approach to antibiotic duration based on time in which CAP patients reach clinical stability during hospitalization. In a multicenter, non-inferiority, randomized, controlled trial hospitalized adult patients with CAP reaching clinical stability within 5 days after hospitalization were randomized to a standard vs. individualized antibiotic duration. In the Individualized group, antibiotics were discontinued 48 h after the patient reached clinical stability, with at least five days of total antibiotic treatment. Early failure within 30 days was the primary composite outcome. 135 patients were randomized to the Standard group and 125 to the Individualized group. The trial was interrupted by the safety committee because of an apparent inferiority of the Individualized group over the Standard treatment: 14 (11.2%) patients in the Individualized group experienced early failure vs. 10 (7.4%) patients in the Standard group, p = 0.200, at the intention-to-treat analysis. 30-day mortality rate was four-time higher in the Individualized group than the Standard group. Shortening antibiotic duration according to patients' characteristics still remains an open question.

[The early management of the sepsis: use of a guidelines document in hospital. Experience at "Carlo Poma" Hospital in Mantova]. / La gestione precoce della sepsi: utilizzo di linee-guida ospedaliere. Esperienza dell'Azienda Ospedaliera "Carlo Poma" di Mantova.

Today the sepsis represents a very important clinical entity. The Surviving Sepsis Campaign assessed an incidence of sepsis equal to 3 cases/1,000 inhabitants. In UK more than 30,000 cases of severe sepsis are calculated; furthermore the patients with sepsis are increasing worldwide (near 18 millions of cases per year). Because of its high mortality, the sepsis represents one of the main causes of death in the world, also in the developing countries where it causes near sixty percent of the total deaths yearly. The early diagnosis and therapy are very important elements for the outcome of the patients. The Authors present the results of the adoption in their hospital of a guidelines document for the management of the septic patient, that show a decrease of their mortality due to the early diagnosis and specific treatments.