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
Diagno...
...Gram Sta...
...mend NOT obtaining sputum Gram stain a...
...ed as severe CAP (see Table 1), es...
...empirically treated for MRSA or P. aer...
.... were previously infected with MRS...
...e hospitalized and received parente...
2. Blood Cul...
...mmend NOT obtaining blood cultures in adults w...
...routinely obtaining blood cultures...
...are classified as severe CAP (see Table...
...ing empirically treated for MRSA or P. aeruginos...
...e previously infected with MRSA or P. aerugin...
...e hospitalized and received parenteral antibiotic...
...Urinary Antigens
...suggest NOT routinely testing urine for...
...dults with severe CAP. (C, L)620...
...T routinely testing urine for Legion...
...ere indicated by epidemiological factors, such...
...with severe CAP (See Table 1). (C,...
...st testing for Legionella urinary an...
...Respiratory Samplin...
...n influenza viruses are circulating in the comm...
Treatment
...eatment
...rocalcitonin...
...mend that empiric antibiotic therapy shoul...
6. Inpatient Versus Outpa...
In addition to clinical judgment, we recomm...
...65 (tool based on confusion, urea level,...
...Treatment Intensity...
We recommend direct admission to an ICU for patie...
...tients not requiring vasopressors or mechanical...
...c Antibiotics – Outpatien...
...moxicillin 1 g three times daily, o...
...e 100 mg twice daily, or (C, L)620
...ithromycin 500 mg on first day then 250...
...herapy: Amoxicillin/clavulanate...
...cycline 100 mg twice daily, or (C, L)for combinat...
...py: Respiratory fluoroquinolone (levofloxacin...
...Empiric Antibiotics –...
...erapy with a beta-lactam (ampicillin+sulbac...
...y with a respiratory fluoroquinolone (levofloxac...
...ion for adults with CAP who have contraindi...
...plus a macrolide; or (S, M)620...
a beta-lactam plus a respiratory fluoroquin...
.... Suspected Aspirat...
...T routinely adding anaerobic coverage...
...1. Extended-spectrum Antibi...
...andoning use of the prior categorization of...
...linicians cover empirically only for MR...
...cians are currently covering empirically for MRSA...
...Steroids...
...nd NOT routinely using corticosteroid...
...e suggest NOT routinely using corticoster...
...suggest NOT routinely using corticosteroids in...
...urviving Sepsis Campaign recommendations on...
.... Antivirals
...recommend that anti-influenza treatment, such...
...anti-influenza treatment be prescr...
...4. Antibiotics for Test-Positive Influenz...
...ommend that standard antibacterial treatment b...
...Treatment Duration...
...nd that the duration of antibiotic thera...
.... Follow-up X-ray...
...adults with CAP whose symptoms have resol...
...2007 IDSA/ATS Criteria for Defining Severe CAPH...
...2. Initial Treatment Strategies for Outpati...
...itial Treatment Strategies for Inpa...