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
...iagnosis
...Gram Sta...
...end NOT obtaining sputum Gram stain and cultu...
...lassified as severe CAP (see Table 1), es...
...are being empirically treated for MRSA or P. a...
...eviously infected with MRSA or P. aeruginosa, es...
...hospitalized and received parenteral ant...
...lood Cultures...
...OT obtaining blood cultures in adults with CAP...
...gest NOT routinely obtaining blood cultur...
...sified as severe CAP (see Table 1) or (S,...
...mpirically treated for MRSA or P. aerugi...
...previously infected with MRSA or P. aeruginosa...
...hospitalized and received parenteral anti...
3. Urinary Anti...
...NOT routinely testing urine for pneumococcal anti...
...adults with severe CAP. (C, L)6...
...T routinely testing urine for Legionella antige...
...e indicated by epidemiological factors, suc...
...lts with severe CAP (See Table 1). (C, L...
...est testing for Legionella urinary antigen a...
.... Respiratory Sa...
...influenza viruses are circulating in the commu...
Treatment
...reatme...
.... Procalcit...
...that empiric antibiotic therapy should be ini...
...ient Versus Outpatient...
...ition to clinical judgment, we recommen...
...e CURB-65 (tool based on confusion, urea level, re...
...Treatment Intensi...
...recommend direct admission to an ICU for pa...
...not requiring vasopressors or mecha...
...ric Antibiotics – Outpatient...
...n 1 g three times daily, or (S, M)...
...100 mg twice daily, or (C, L)620...
...ide (azithromycin 500 mg on first d...
...mbination therapy: Amoxicillin/clavu...
...e 100 mg twice daily, or (C, L)for combination...
...rapy: Respiratory fluoroquinolone (levof...
...mpiric Antibiotics – Inpati...
...ion therapy with a beta-lactam (ampicillin...
...therapy with a respiratory fluoroquin...
...d option for adults with CAP who have contraindi...
...eta-lactam plus a macrolide; or (S, M)...
...ta-lactam plus a respiratory fluoroqui...
...pected Aspiration...
...T routinely adding anaerobic coverage f...
...ed-spectrum Antibiotics...
...ecommend abandoning use of the prior categori...
...recommend clinicians cover empirically o...
...clinicians are currently covering empirically for...
...2. Steroid...
...nd NOT routinely using corticoster...
...outinely using corticosteroids in adults...
...ggest NOT routinely using corticost...
...e Surviving Sepsis Campaign recommendations o...
.... Antiviral...
...mend that anti-influenza treatment, such...
...uggest that anti-influenza treatment be prescribed...
...s for Test-Positive Influenza...
...ommend that standard antibacterial treatment be...
...atment Duration
...at the duration of antibiotic therapy should be...
...6. Follow-up X-r...
In adults with CAP whose symptoms hav...
...7 IDSA/ATS Criteria for Defining Sever...
...2. Initial Treatment Strategies f...
...l Treatment Strategies for Inpatient...