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
1. Gram Stain
...ommend NOT obtaining sputum Gram stain and cu...
...e classified as severe CAP (see Table 1), especial...
...are being empirically treated for MRSA or P. aeru...
...previously infected with MRSA or P. aerugin...
...e hospitalized and received parenteral anti...
2. Blood Cultu...
...NOT obtaining blood cultures in adults with CAP...
...t NOT routinely obtaining blood cultures in ad...
...lassified as severe CAP (see Table 1) or (S...
...are being empirically treated for MRSA o...
...were previously infected with MRSA or P. aerugino...
...hospitalized and received parenteral antibiotics...
.... Urinary Anti...
...e suggest NOT routinely testing urine for pn...
...ults with severe CAP. (C, L)620...
...e suggest NOT routinely testing ur...
...n cases where indicated by epidemiologic...
2. in adults with severe CAP (See Tabl...
...ting for Legionella urinary antigen...
...iratory Sampling...
...a viruses are circulating in the community,...
Treatment
Treatmen...
...ocalcitonin...
...ommend that empiric antibiotic therapy...
...ent Versus Outpatient...
...tion to clinical judgment, we recommend...
...(tool based on confusion, urea le...
...Treatment Intens...
...recommend direct admission to an IC...
...ot requiring vasopressors or mechanical ven...
...ntibiotics – Outpatient...
...llin 1 g three times daily, or (S, M)620
...xycycline 100 mg twice daily, or...
...lide (azithromycin 500 mg on first day then 250 mg...
...ombination therapy: Amoxicillin/cla...
...ne 100 mg twice daily, or (C, L)for com...
...Respiratory fluoroquinolone (levofloxacin 750...
...piric Antibiotics – Inpatient...
...ombination therapy with a beta-lactam (ampicillin+...
...therapy with a respiratory fluoroquinolone...
...tion for adults with CAP who have contraind...
...lactam plus a macrolide; or (S, M)620
...eta-lactam plus a respiratory fluoroqui...
...0. Suspected Aspirat...
...est NOT routinely adding anaerobic co...
...ended-spectrum Antibiotics...
...abandoning use of the prior categorization...
...mmend clinicians cover empirically only for...
...linicians are currently covering empirical...
...Steroids
...recommend NOT routinely using corticost...
...est NOT routinely using corticosteroids in adults...
...NOT routinely using corticosteroids in...
...endorse the Surviving Sepsis Campaign rec...
13. Antivirals
...recommend that anti-influenza treatm...
...t anti-influenza treatment be prescri...
...4. Antibiotics for Test-Posit...
...nd that standard antibacterial treatme...
...Treatment Duration...
...hat the duration of antibiotic therap...
...ollow-up X-ra...
...lts with CAP whose symptoms have r...
Table 1. 2007 IDSA/ATS Criteria for Def...
...2. Initial Treatment Strategies for Outpatien...
...nitial Treatment Strategies for Inp...