Pneumonia in elderly patients with preexisting respiratory disease

To evaluate the optimal duration of appropriate antibiotic therapy for pneumonia in elderly patients with preexisting respiratory disease, we studied improvement of infectious parameters in these patients. The medical record database was used to identify patients admitted with the following characteristics: primary diagnosis of benign respiratory disease; aged 65 years or over; no active malignant diseases in any organs; and at least one admission for pneumonia during April 2001 to May 2003. We observed 47 pneumonia episodes in 30 patients. Elevated CRP levels more than 8.0 mg/ml and leukocytosis more than 10.0 x 10(3) mm(-3) was seen in 21 and 29 pneumonia episodes, respectively. With appropriate intravenous antimicrobial therapy, average of CRP levels on day 0 (9.16 +/- 6.81 mg/dl) decreased to 5.18 +/- 4.67 mg/dl on day 3 (P = 0.0073). In more than 70% of pneumonia episodes, serum levels of CRP normalized on day 10. Average of leukocyte counts on day 0 ((12.3 +/- 4.7) x 10(3) mm(-3)) decreased to (8.1 +/- 3.5) x 10(3) mm(-3) on day 3 (P = 0.0001). In more than 80% of pneumonia episodes, leukocyte count normalized on day 7. The clinical response to appropriate antimicrobial therapy for pneumonia occurs within the first 3 days of therapy. Duration of intravenous antimicrobial therapy for pneumonia in these patients of 10 days would be sufficient and could prevent recurrent infection with resistant bacteria.