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
...Diagnosi...
...1. Gram Stain...
We recommend NOT obtaining sputum Gram s...
...d as severe CAP (see Table 1), especially...
...mpirically treated for MRSA or P. aerugino...
...viously infected with MRSA or P. aeru...
....c. were hospitalized and received parenter...
...2. Blood...
...OT obtaining blood cultures in adu...
...NOT routinely obtaining blood cultures in adults w...
...ified as severe CAP (see Table 1) or (S, VL)620...
....a. are being empirically treated for M...
...previously infected with MRSA or P. aeruginosa...
...hospitalized and received parenteral anti...
...3. Urin...
...NOT routinely testing urine for pneumoco...
...dults with severe CAP. (C, L)620...
...uggest NOT routinely testing urine f...
...cases where indicated by epidemiologica...
...adults with severe CAP (See Table 1)....
...testing for Legionella urinary antigen and...
...4. Resp...
...influenza viruses are circulating in the communit...
Treatment
...Treatm...
...5. Pro...
...ecommend that empiric antibiotic therapy should be...
...6. Inpatient...
...ddition to clinical judgment, we recommend...
over the CURB-65 (tool based on confus...
...7. Treatment In...
...nd direct admission to an ICU for pati...
...r patients not requiring vasopressors or m...
...8. Empir...
...oxicillin 1 g three times daily, or...
...ne 100 mg twice daily, or (C, L)620...
...crolide (azithromycin 500 mg on fir...
...apy: Amoxicillin/clavulanate 500 mg...
...e 100 mg twice daily, or (C, L)for co...
...py: Respiratory fluoroquinolone (levofloxacin...
...9. Empiric Antibio...
...ion therapy with a beta-lactam (ampicillin+sulbac...
...apy with a respiratory fluoroquinolone (lev...
A third option for adults with CAP who h...
...actam plus a macrolide; or (S,...
...lactam plus a respiratory fluoroqu...
...10. Suspected...
...suggest NOT routinely adding anaero...
...11. Ext...
...end abandoning use of the prior categorization of...
...end clinicians cover empirically only for MRS...
...linicians are currently covering em...
...12....
...mmend NOT routinely using corticosteroids in adul...
...gest NOT routinely using corticostero...
...gest NOT routinely using corticosteroids in adult...
...the Surviving Sepsis Campaign recommendations...
...13. Antivirals...
...commend that anti-influenza treatment, such...
...that anti-influenza treatment be prescribed...
...14. Antibiotics for...
...recommend that standard antibacteria...
...15. Treatment Duration...
...nd that the duration of antibiotic therapy...
...16. Follow-up X-ra...
...n adults with CAP whose symptoms have...
...IDSA/ATS Criteria for Defining Severe...
Table 2. Initial Treatment Strategie...
...Initial Treatment Strategies for Inpatients wi...