Conundrums in community-acquired pneumonia

A recent article in the Journal by Charles et al2 omitted a role for HIH in managing community-acquired pneumonia (CAP). Where their protocol mentions outpatient care, readers are led to interpret this as oral therapy only, managed by a general practitioner. Similarly, it is implied that inpatient therapy relates to traditional treatment in a hospital ward. No further clarification is given. This is a surprising omission, given that one of the authors has written extensively in support of HIH in the past.3

HIH administers hospital-level therapy (intravenous antibiotics, oximetry, rehydration, medical and nursing attendance, with 24-hour cover) to a clinical subgroup of CAP patients who can be defined and included within any protocol.

Evidence suggests that HIH can offer effective and safe treatment of patients with acute CAP referred directly from hospital emergency departments after diagnosis.4-6 Many patients with pneumonia appreciate the option of well organised, acute, home-based care. An important and growing subgroup of patients living in residential nursing care facilities can also receive acute CAP treatment in facilities with HIH involvement.7 A significant proportion of patients receiving HIH care have failed oral therapy.4-7

Why the omission of HIH? Protocols are tools of influence to be tussled over. This sometimes conflicts with their general aim of organising science into process and progress. Fine and colleagues’ intent in investigating the use of pneumonia severity scores was to help address the question of where and how to treat acute pneumonia. One of the aims of developing scores was to broaden the treatment options, not to narrow them.