Cefazolin vs Penicillin

To the Editor.—  The data presented in the article "Cefazolin vs Penicillin: Treatment of Uncomplicated Pneumococcal Pneumonia" (241:2815, 1979) only support the conclusion that cefazolin sodium is as effective but not superior to penicillin G procaine for uncomplicated pneumonia from Streptococcus pneumoniae in a patient population not severely ill. Contrary to the authors' implications, cefazolin alone is completely inappropriate for the initial treatment of pneumonias due to Gram-negative bacillary organisms, since many of the Enterobacteriaceae and pseudomonads are insensitive. Mycoplasma pneumoniae, which remains a more important pulmonary pathogen than Gram-negative rods in nonhospitalized patients, also is resistant to cefazolin. Additionally, cefazolin has been associated with elevations in BUN¹ and is contraindicated in patients with immediate type of penicillin hypersensitivity. Consequently, it becomes difficult to assign a niche for cefazolin in the initial treatment of pneumonias in either hospitalized or clinic patients.