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The book will be of value to the infectious-disease specialist, respirologist, or intensivist who deals with severe community-acquired pneumonia. It is easy to read and provides an up-to-date summary of a number of controversial areas in the care of patients with severe community-acquired pneumonia. The combination of two viewpoints on each topic results in very little incremental value -- instead, there is considerable duplication in the second chapter on each topic. The editors would do well to reconsider this strategy. The same goals could be accomplished by having a commentary at the end of each chapter to provide another viewpoint.
An introductory chapter dealing with the definition, epidemiology, causes, and outcomes of severe community-acquired pneumonia would have been worthwhile. Instead, the book opens with two chapters on the management of respiratory failure in severe community-acquired pneumonia. These two chapters will be of value to the intensivist, since they deal with issues that relate to mechanical ventilation.
The approach after these first two chapters is to address Legionella pneumophila, penicillin-resistant S. pneumoniae, and the role of Pseudomonas aeruginosa in community-acquired pneumonia. All these microorganisms can cause severe community-acquired pneumonia, and some aspects of their management -- such as the decision to include empirical therapy for P. aeruginosa in treating patients who present with severe community-acquired pneumonia -- are controversial. The chapters on the problem of penicillin-resistant S. pneumoniae and the role of P. aeruginosa in community-acquired pneumonia are both good reviews of these topics. The last two chapters deal with the role of alcohol in severe pneumonia and acute lung injury and adjunctive therapies for severe community-acquired pneumonia.
The chapters that are likely to be most valuable to the reader are those on the role of alcohol in severe pneumonia and acute lung injury and on adjunctive therapies for severe community-acquired pneumonia. They provide excellent summaries of each subject and stand out by virtue of the fact that up-to-date reviews of these topics are not readily available in other sources. These two chapters alone make the book a worthwhile purchase. My disappointment with the book was that no effort was made to provide direction for future research in an area that suffers from the lack of a standard definition and a scarcity of evidence from randomized clinical trials.
Thomas J. Marrie, M.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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