Cost-Effectiveness and Antimicrobial Resistance in Community-Acquired Pneumonia

COMMUNITY-ACQUIRED PNEUMONIACommunity-acquired pneumonia (CAP) covers those infections of the lung parenchyma that are not acquired in hospital or a long-term care facility.CAP is a common infectious disease, with annual incidence rates of 1.6 per 1,000 adults in Spain and 11.6 per 1,000 adults in Finland [1,2].CAP is associated with significant morbidity and is the leading cause of death due to infection in developed countries [3,4].The economic burden of CAP is substantial: in the United States, CAP accounts each year for 10 million physician visits, and about 1 million hospitalizations at an estimated hospital cost of $9 billion [5,6]. ANTIMICROBIAL TREATMENTPatients suffering from mild to moderate CAP are generally treated with oral antimicrobials in the community [7].Hospitalisation may be required for elderly patients, patients who have underlying chronic illnesses or patients with more serious disease.In the majority of patients [4], antimicrobial treatment is empirical in that treatment is initiated in the absence of information about the causative pathogen involved in CAP and the antimicrobial susceptibility pattern of the isolated organism.The empirical approach is also the prevailing method of drug selection [8].The treatment approach to CAP is challenging due to the expanding spectrum of causative pathogens, the rising prevalence of resistance to antimicrobial agents and the increasing pressure to reduce the length of hospitalization [9].Various professional societies have published clinical guidelines to guide antimicrobial treatment of CAP [10,11].These guidelines recommend a beta-lactam-based therapy for CAP as first choice.Moxifloxacin monotherapy is a useful alternative for outpatients with comorbid conditions, outpatients in whom infection with atypical pathogens (in particular Legionella spp.) needs to be taken into consideration, inpatients who do not require intensive care unit care, patients recently treated with other antibiotics, and patients