1. Combination antibiotic therapy bacteremic pneumococcal pneumonia: PRO Antoni Torres. Universitat de Barcelona. Spain

2. IDSA/ATS Clin Infect Dis 2007;44:S27-72

5. 14-d mortality Combination therapy: 23.4% Monotherapy: 55.3% p = 0.0015

11. Patients on MV Although in patients on MV, the cure rate and overall mortality rates were not statistically different in both treatment groups, the noninferiority of L to C + O could not be demostrated. Chest. 2005; 128:172-183.

12. Β -lactam and Macrolide Combination Therapy vs. Fluoroquinolone Monotherapy BL+M F BL+M F Antimicrob Agents Chemother 2007; 51: 3977-3982. 0 30 50 10 20 40 Mortality (%) PSI 4 PSI 5 p=0.6 p=0.05

13. What agents? Macrolides or fluoroquinolones? That’s the question .

14. 172 episodes of severe CAP Multivariate analysis. 30-day Mortality B-lact+fluoroq OR 2.71 (95%IC 1.2-6.1)

20. S pneumoniae resistance (Barcelona) Am J Resp Crit Care Med 1999; 159: 1835-1842 Chest 2006; 130: 800-806 Penicillin Cefotaxime Eritrhomycin *Significant difference 0 20 60 100 80 40 Resistance (%) 1999-2002 (N= 123) 1996-1998 (N=101) * *

23. Virulence factors of S pneumoniae

26. Patients with CAP who do not require ICU admission Length of stay (days) AZT CLT 0 6 10 2 4 8 Mortality (%) AZT CLT Clin Infect Dis 2003; 36:1239-1245. 0 6 10 2 4 8

30. Delay of antimicrobial therapy and mortality Arch Intern Med 2004; 164: 637-644

31. Kumar, et al. Crit Care Med 2006;34:1589–1596 Risk of death with increasing antimicrobial delay: subgroups X, delay (hours) Adjusted odds ratio of death 1.0 1.1 1.2 1.3 All Documented Suspected Culture + Culture - Bacteraemia + Bacteraemia - Community Nosocomial Gram + Gram - Fungal Respiratory Urinary tract Intra-abdominal Skin/soft tissue 1385 769 608 1546 459 1695 2154 N 912 1242 768 584 838 131 230 156 641