In order to determine the causes of treatment failure in
community-acquired pneumonia (CAP) clinical trials, a MEDLINE search for
all CAP studies published between 1990 and 1997 was performed.
Prospective, randomized studies comparing the efficacy of two or more
antibiotics in CAP were selected. Treatment failure was defined as
persistent fever, deterioration of patient's condition, or a change in
the prescribed antibiotic regimen. In 16% of the cases included in the
clinical trials, the treatment of CAP is unsuccessful. A significant
number of identified failure cases were owing to antibiotic
side-effects. Resistant pathogens are an unusual cause of failure
whatever the antibiotic used.
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