Diagnosis and Treatment of Adults with Community-Acquired Pneumonia

Publication Date: October 1, 2019

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 Stain...

...nd NOT obtaining sputum Gram stain and c...

...ified as severe CAP (see Table 1), esp...

...are being empirically treated for MRSA or P....

...were previously infected with MRSA...

....c. were hospitalized and received par...


...ood Cultures...

...mmend NOT obtaining blood cultures in a...

...e suggest NOT routinely obtaining bl...

...classified as severe CAP (see Table 1) or (S, VL)...

...a. are being empirically treated for MRSA...

...eviously infected with MRSA or P. aeruginosa,...

....c. were hospitalized and received parenteral ant...


...nary Antigens...

...routinely testing urine for pneumococcal...

except in adults with severe CAP. (...

...suggest NOT routinely testing urine for L...

...cases where indicated by epidemiological factors,...

...s with severe CAP (See Table 1). (C,...

...ting for Legionella urinary antigen and col...


...piratory Sampling...

...influenza viruses are circulating in th...


Treatment

...reatmen...

...rocalcitonin...

...mmend that empiric antibiotic therapy should b...


...patient Versus Outpati...

...on to clinical judgment, we recommend that...

...the CURB-65 (tool based on confusio...


...atment Intensity...

...e recommend direct admission to an IC...

...ients not requiring vasopressors or mechanical...


...ric Antibiotics – Outpati...

...three times daily, or (S, M)620...

...line 100 mg twice daily, or (C,...

...(azithromycin 500 mg on first day then 250 m...

...bination therapy: Amoxicillin/clav...

...r doxycycline 100 mg twice daily, or (C, L)...

...erapy: Respiratory fluoroquinolone...


...Antibiotics – Inpatient...

...apy with a beta-lactam (ampicillin+sulbact...

...herapy with a respiratory fluoroquinolone...

...rd option for adults with CAP who have co...

...plus a macrolide; or (S, M)620...

...am plus a respiratory fluoroquinol...


...Suspected Aspira...

...suggest NOT routinely adding anaerobic coverage fo...


11. Extended-spectrum Ant...

...recommend abandoning use of the prior categor...

...mend clinicians cover empirically only for M...

...cians are currently covering empirically for...


...Steroids...

...nd NOT routinely using corticosteroids in adults...

...e suggest NOT routinely using corticos...

...NOT routinely using corticosteroids in adults with...

...endorse the Surviving Sepsis Campaign rec...


13. Antivir...

...e recommend that anti-influenza treatment,...

...hat anti-influenza treatment be prescribed for...


...otics for Test-Positive Influenza...

We recommend that standard antibacterial...


...5. Treatment Durati...

...hat the duration of antibiotic therapy should...


...Follow-up X-ray...

...h CAP whose symptoms have resolved within 5-7 d...


...07 IDSA/ATS Criteria for Defining Severe C...


...itial Treatment Strategies for Outpatients...


...Initial Treatment Strategies for Inpat...