In Europe and North America, pneumonia represents the sixth cause of death overall and is the leading cause among infectious diseases, affecting approximately 8-15 of 1000 people annually. Among the infectious diseases, pneumonia also has a predominant role because of the high cost of associated healthcare resources. Mortality in patients with community acquired pneumonia who receive home-based health assistance is around 1-5%; hospitalized patients (about 20% of patients with pneumonia) have a mortality rate that approaches 10-15% in general medical wards and 40% for those who are hospitalized in intensive care units. Mortality is largely influenced by comorbidities: congestive heart failure, COPD, cachexia, immunodeficiency, alcoholism and diabetes mellitus were seen to worsen the prognosis. In the elderly, more frequently these comorbidities are responsible for the inauspicious scenario; about 90% of deaths due to pneumonia are in patients above the age of 65 years.
This issue of Hot Topics in Respiratory Medicine is dedicated to this important topic − from epidemiology to guidelines, this analysis is intended to depict the important role of macrolide therapy for pneumonia. In particular, the Ott et al. article will review updated data concerning epidemiology and etiology of community acquired pneumonia, with a close analysis of the epidemiologic role of bacterial resistance and the etiologic influence of viral and atypical pathogens. Carbonara et al. will introduce and discuss the most recent guidelines for the management of community-acquired pneumonia. Based on the latest clinical trials, where adherence to guidelines was also evaluated, it was unambiguously demonstrated that adherence is largely related to a better prognosis. Thus, the knowledge and implementation of the guidelines are confirmed to be fundamental for appropriately managing patients with pneumonia.
In conclusion, Anzueto will present data on the role of macrolides, with a focus on clarithromycin, for the treatment of pneumonia. The article deals with the bacterial resistance problem, in particular that of Streptococcus pneumonia, and the burden of bacterial resistance as a risk factor in the management of pneumonia. Data confirm the antibacterial, anti-inflammatory and immunomodulatory activity of macrolides and the authors underline how the positive interaction of these characteristics are responsible for the persistent efficacy of macrolides in pneumonia therapy, in particular for severe pneumonia.
It is my opinion that this issue of Hot Topics in Respiratory Medicine provides a wealth of information and guidance, and that it will prove to be a useful tool in keeping accurately updated on issues associated with the treatment of pneumonia.