Journal Article

Management of Nonsevere Pneumonia in Military Trainees with the Urinary Antigen Test for <i>Streptococcus pneumoniae:</i> An Innovative Approach to Targeted Therapy

Igor A. Guchev, Victor L. Yu, Alexander Sinopalnikov, Oleg I. Klochkov, Roman S. Kozlov and Leonid S. Stratchounski

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 11, pages 1608-1616
Published in print June 2005 | ISSN: 1058-4838
Published online June 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/429919
Management of Nonsevere Pneumonia in Military Trainees with the Urinary Antigen Test for Streptococcus pneumoniae: An Innovative Approach to Targeted Therapy

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Background

The drug of choice for treatment of Streptococcus pneumoniae infection is generally a penicillin (including amoxicillin). Targeted therapy is, however, rarely used, because results of definitive diagnostic tests for pneumonia are not available for several days. Thus, broad-spectrum antibiotics are used for empirical treatment of pneumonia to cover both typical and atypical pathogens. Our purpose was to assess the usefulness of a strategy of targeted antimicrobial therapy based on the results of a rapid urinary antigen test for S. pneumoniae.

Methods

Military trainees with pneumonia were prospectively assigned to 2 groups: patients with positive urinary antigen test results who were treated with amoxicillin (1000 mg 3 times per day), and patients with negative urinary antigen test results who were treated with clarithromycin (500 mg 2 times per day). The duration of therapy was 5–10 days for both groups.

Results

A total of 219 evaluable patients were enrolled in the study. The most common causes of pneumonia were S. pneumoniae, Chlamydia pneumoniae, and Mycoplasma pneumoniae. Patients with positive urinary antigen test results had illness of greater severity at the time of study entry. Twenty-two percent of patients had positive urinary antigen test results (i.e., the amoxicillin group), and 78% had negative urinary antigen test results (i.e., the clarithromycin group). The clinical success rates were 94% for the clarithromycin group and 90% for the amoxicillin group (P = not significant). None of the patients who were classified as having treatment failure died. Resolution of clinical manifestations was slower for patients with pneumococcal pneumonia defined by a positive urinary antigen test result.

Conclusions

The urine antigen test allowed targeted use of a penicillin (amoxicillin) for young immunocompetent individuals with nonsevere, community-acquired pneumonia. Clarithromycin was highly effective against both S. pneumoniae pneumonia and pneumonia due to atypical pathogens.

Journal Article.  5231 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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