Diagnosis and Treatment of Adults with Community-Acquired Pneumonia
Key Points
Key Points
- This guideline addresses the clinical entity of pneumonia that is acquired outside of the hospital setting in patients in the U.S. who have not recently completed foreign travel and who do not have an immunocompromising condition.
- Antibiotic recommendations for the empiric treatment of community-acquired pneumonia (CAP) are based on selecting agents effective against the major treatable bacterial causes of CAP.
- Traditionally, these bacterial pathogens include Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Staphylococcus aureus, Legionella species, Chlamydia pneumoniae, and Moraxella catarrhalis.
- In addition, the emergence of multidrug-resistant pathogens, including methicillin-resistant S. aureus (MRSA) and Pseudomonas aeruginosa require separate recommendations when the risk of each of these pathogens is elevated.
- Other, far less common, multidrug-resistant Enterobacteriaceae can cause CAP, including organisms producing extended-spectrum beta-lactamase (ESBL). Those organisms are effectively covered by P. aeruginosa strategies and are therefore not otherwise mentioned.
- Bacterial pathogens often co-exist with viruses, and there is no current diagnostic test accurate enough or fast enough to determine that CAP is due solely to a virus at the time of presentation. Therefore, our initial recommendations are to treat empirically for possible bacterial infection or co-infection.
Diagnosis
...agnosis
.... Gram Stain
...e recommend NOT obtaining sputum Gram stain a...
...ified as severe CAP (see Table 1), especially if t...
....a. are being empirically treated for...
...ously infected with MRSA or P. aeruginosa, esp...
...talized and received parenteral antibiotics...
...Blood Cultures...
...d NOT obtaining blood cultures in adults with...
...NOT routinely obtaining blood cultures...
...are classified as severe CAP (see Table 1) or (S...
...g empirically treated for MRSA or P. aeruginosa o...
...previously infected with MRSA or P. aerug...
...were hospitalized and received parenteral antibio...
...Urinary Antigens...
...ggest NOT routinely testing urine...
...in adults with severe CAP. (C, L)620...
...OT routinely testing urine for Legionella an...
...s where indicated by epidemiological factor...
...ults with severe CAP (See Table 1). (C, L)620...
...suggest testing for Legionella urinary antig...
4. Respiratory Sam...
...luenza viruses are circulating in the communit...
Treatment
...eatment
...rocalcitonin...
...that empiric antibiotic therapy should be initiat...
6. Inpatient Versus Outpatien...
...ion to clinical judgment, we recommend that clini...
...CURB-65 (tool based on confusion, urea level, re...
...reatment Intensity...
...mend direct admission to an ICU for pat...
...requiring vasopressors or mechanica...
...Antibiotics – Outpatient...
...three times daily, or (S, M)620...
...ycline 100 mg twice daily, or (C...
...acrolide (azithromycin 500 mg on first da...
...apy: Amoxicillin/clavulanate 500 mg/1...
...ycycline 100 mg twice daily, or (C, L)for com...
...Respiratory fluoroquinolone (levofloxaci...
...ric Antibiotics – Inpatient...
...ion therapy with a beta-lactam (ampicillin...
...rapy with a respiratory fluoroquinolone...
...rd option for adults with CAP who have contraindic...
...plus a macrolide; or (S, M)620
...ta-lactam plus a respiratory fluoroquinolone....
10. Suspected Aspi...
...gest NOT routinely adding anaerobic coverage fo...
...d-spectrum Antibiotics...
...andoning use of the prior categorizat...
...mmend clinicians cover empirically only...
...s are currently covering empirically for MRSA or...
12. Ster...
...end NOT routinely using corticoster...
...ggest NOT routinely using corticosteroids in adu...
...routinely using corticosteroids in a...
...the Surviving Sepsis Campaign recommendations...
13. Antivirals
...mend that anti-influenza treatment...
...t that anti-influenza treatment be prescribed for...
...ics for Test-Positive Influenza...
...recommend that standard antibacteri...
...atment Duration...
...ecommend that the duration of anti...
...ollow-up X-ray...
...dults with CAP whose symptoms have resolved within...
...2007 IDSA/ATS Criteria for Defining Severe CA...
...le 2. Initial Treatment Strategies f...
...ial Treatment Strategies for Inpatie...