to the editor: The article by Drs. King and Pippin¹ on initial antibiotic therapy in community-acquired pneumonia was a comprehensive review of drug therapy for patients with community-acquired pneumonia on an outpatient and inpatient basis and in younger versus older adults. However, since community-acquired pneumonia is a common infection and is the leading cause of death related to infectious disease, more emphasis could have been placed on the use of pneumococcal vaccination in controlling or preventing pneumococcal pneumonia in elderly and high-risk patients with chronic disease.

Fedson² showed in case-control studies and indirect cohort studies that pneumococcal vaccination is effective in preventing invasive pneumococcal disease in patients who are older or who are at higher risk. The Office of Technology Assessment has also shown that pneumococcal vaccination is cost-effective in preventing pneumococcal pneumonia in elderly persons.² The cohort study showed that patients who were discharged after being treated for pneumonia had a 6 to 9 percent probability of readmission with pneumonia within five years and that each such readmission could be prevented by immunizing discharged patients with pneumococcal vaccine. The study also showed that the costs of vaccination would equal approximately one third the costs of hospital care for unvaccinated patients who were discharged and then readmitted with pneumonia; the authors recommend that elderly patients be immunized with pneumococcal vaccine on discharge from the hospital.

Another article by Gable and colleagues³ evaluated the efficacy and cost savings of the pneumococcal pneumonia vaccine in a retrospective cohort study; the investigators concluded that the pneumococcal vaccine is effective in persons who have had pneumonia, persons who are at risk of developing pneumonia, and persons who are over 50 years of age.

Family physicians need to place greater emphasis on giving pneumococcal vaccine to the elderly and others who are at risk for pneumonia.