Turkish Journal of
GERIATRICS

Gata Haydarpaşa Eğitim Hastanesi İç Hastalıkları Servisi, İstanbul
Gata Haydarpaşa Eğitim Hastanesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Servisi, İstanbul
Gata HaydarpaÅŸa EÄŸitim Hastanesi, Radyoloji Servisi, Ä°stanbul Community-acquired pneumonia (CAP) is one of the common cause of mortality and morbidity. Initial treatment of CAP is often empiric. The aim of this study was to analyse whether there was a difference in prognosis and mortality when using sulbactam/ampicillin (SAM) or ceftazidime (CAZ) in elderly (>65 year-old) patients. Clinical records of those patients treated for CAP with SAM or CAZ were reviewed between November 1999 through November 2000 in our unit. The main underlying conditions and demographic features of the patients were determined. CAP diagnosis was done according to guideline of the CAP Study Group of Turkish Thorax Society. Patients who died on first day of admission or those requiring mechanical ventilation were excluded. Among 67 patients who has appropriate criteria for the study 42 (62%) patients were determined as a group 3 and 25 (38%) were group 4. Statistical analysis included Chi-square test and P <0.05 was considered significant. 32 patients were given SAM and 35 CAZ. Among 67 patients, 30 (45%) required a complete change of antibiotic or modification of antibiotic to treat the identified pathogen or unresponsiveness of initial treatment after first three days. There were 85% comorbid diseases (diabetes, hypertension, chronic obstructive lung disease, heart failure, serebro vascular disease, malignancy) in SAM group and 83% in CAZ group. Recovery rates of SAM and CAZ group were 15 (47%) and 22 (63%) respectively and there was no statistical difference in between both groups (X2 : 1.86 , P>0.05). Mortality rates were 28% in SAM group and 20% in CAZ group with no statistically difference (X2: 0.551, P>0.05). Bacteriologic identification could be obtained in 21 (31.7) patients. Eight of them were Streptococcus pneumonia, 5 were Escherichia coli, 4 were Enterobacter spp., 2 were Klebsiella pneumoniae and 2 were Staphylococcus aureus. As conclusion, there were no difference on recovery rates of SAM and CAZ groups and both of them were low. Since high mortality rates in the elderly patients with CAP were observed in group 3 and group 4 we think that we need prospective controlled studies for more effective empiric antibiotic protocols and preventive measurements as vaccination against CAP agents. Keywords :