The comparasion of alternative approaches in group i, ii and iii patients in Guide of Diagnosis and Treatment of Turkish Thoraks Society National Community Acquired Pneumonia

Background: In this study we aimed to compare the alternative treatment approaches that proposed in the Turkish Thoracic Society Guide of Diagnosis and Treatment Community Acquired Pneumonia in adults and also it was aimed to have an idea about that which treatment approach more effective.Material and Methods: This studay was designed for groups I, II and III paitents with communty acquired pneumonia in Karadeniz Technical University School of Medicine date on between March 2007 and Sept 2008. Unfourtunatelly, groups I, II and IIIa patients which determined according to 2002 Turkish Thoracic Society Community Acquird Pneumonia Diagnosis and Treatment Guideline criteria, were exluded because of limited number of patients. Thirty six cases in group IIIb were included into the study and they were randomised into two groups according to incoming date. First group who were treated with intravenous (IV) ceftriaxone 1 gr twice daily plus intravenous clarithromycin 500 mg twice daily. Second group were treated with IV moxifloxacin 400 mg once daily. As sequential therapy, oral cefuroxime axetil 500 mg twice daily plus oral clarithromycin twice daily were administrated in first group and oral moxifloxacin 400 mg daily was given in the second group. Clinical, laboratuary and radiographical finding were compared in both of groups.Biochemical parameters were computed with using Student-t test or Mann Whitney U tests according to their parametric or nonparametric distribution. The fever response to treatment was evaluated with chi square test. Sputum, cough and radiological findins were compared by using Mann Whitney U test.Results: Mean age of both groups were found to be the same as 65 yr. Gender distribution was similar in both group. However, 23 patients of 36 (63.9%) were men. The most common risk factor was co-morbid diseases and the most common diseases were congestive heart failure (25%), chronic obstructive pulmonary disease (22.2%) and diabetes mellitus (13.8%) respectively. The most frequently observed severity factor was parapneumonic effusion (36.1%) and the symptoms were sputum (97.2%) and cough (94.4%). Radiologicaly, lober consolidation were found in 29 patients (80%) and intestitial infiltrationwere detected in 7 patients (19,4%). Bacteriologic examination yielded a pathogen in 7 patients (19.44%) and S. pneumoniae was most frequently isolated agent. At the end of the 14 day following process, similar clinical, radiologic and laboratuary results were found in both groups. There were no difference in both groups in terms of treatment and hospitalizasyon time. Time to oral therapy was significantly longer in combination arm (5.89±1.72 vs. 4.94±0.53).Conclusion: Treatment of the patients according to 2002 Turkish Thoracic Society CAP Guideline was succesful in %97 of all patients. We determined that administation of moxifloxacin once daily was as effective as ceftriaxone plus clarithromycin treatment. Similar clinical success rates were determined in both groups.