Editor—Owen et al highlight the possibility that intravenous antibiotics may be overprescribed to patients with non-severe community acquired pneumonia.1 The guidelines of the “Surviving Sepsis” campaign for managing severe sepsis and septic shock recommend “intravenous antibiotic treatment should be started within the first hour of recognition of severe sepsis, after appropriate cultures.”2
Some of the literature referenced by the Surviving Sepsis campaign uses the fulfilment of two out of four of the criteria for the systemic inflammatory response syndrome and a systolic blood pressure less than 90 mm Hg as indicative of sepsis. Given the difference between these criteria and CURB criteria, a patient apparently not deemed suitable for intravenous antibiotic treatment of pneumonia by the CURB criteria could be recommended for aggressive treatment of sepsis (including central venous and arterial access) by the campaign's guidelines.
This apparent contradiction illustrates the continued importance of overall clinical assessment in our increasingly guideline driven management of patients.
Competing interests: None declared.
References
- 1.Owen D, Shiner T, Sivakumar R, Dent R, Hilton C. Pneumonia. BMJ 2006;332: 1213. (20 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving sepsis campaign (SSC) guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32: 858-73. [DOI] [PubMed] [Google Scholar]