Our firm has recently seen in increase in cases where healthy adults in the 50-60 year age group had flu-like symptoms, then rapidly developed pneumonia, and then died shortly afterwards from sepsis. Our experience, of course, doesn’t necessarily reflect the actual statistics of this phenomenon. But a recent article pointed out that studies show that one in four adults who have community-acquired pneumonia receive appropriate standard antibiotics but do not respond to the treatment. As in the cases we reviewed, they then end up in the ER and are hospitalized.

Current treatment generally follows guidelines from the American Thoracic Society and the Infectious Disease Society of America, which were published in 2007. But the article contends that “large scale, real-world data are needed to better understand and optimize antibiotic choices and to better define clinical risk factors that may be associated with treatment failure.”

There are data in the medical literature that points out that risk factors for treatment failure are known: older patients, and those with certain co-morbidities. Age-related differences in treatment outcome are significant. Patients over the age of 65 are twice as likely to be hospitalized even after antibiotic treatment for pneumonia, even when other risk factors are included in the analysis.

As a result of this data, many physicians are now recommending more aggressive antibiotic therapy for older patients. Somewhat surprisingly, the recent study also found substantial regional variations in treatment outcomes, although the reasons for this are not clear. Finally, it found that patients with co-morbidities such as COPD, cancer, and diabetes, were not being treated with combination antibiotic therapy or respiratory fluoroquinolones, as the guidelines recommend.