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
...Diagnosis...
...1. Gram Stain...
...NOT obtaining sputum Gram stain and culture ro...
1. are classified as severe CAP (see Table 1),...
...ng empirically treated for MRSA or...
...previously infected with MRSA or P. aeru...
...italized and received parenteral antib...
...2. Blood Cultures...
...e recommend NOT obtaining blood cultures...
...T routinely obtaining blood cultures in adults w...
...d as severe CAP (see Table 1) or (S, VL)620...
....a. are being empirically treated for MRSA or...
...were previously infected with MRS...
...e hospitalized and received parenteral a...
...3. Urinary Ant...
...gest NOT routinely testing urine for pneumococcal...
...cept in adults with severe CAP. (C, L)620...
...gest NOT routinely testing urine for L...
...in cases where indicated by epidemiologi...
...th severe CAP (See Table 1). (C, L)620...
...t testing for Legionella urinary antigen...
...4. Respiratory Sampling...
...fluenza viruses are circulating in the commun...
Treatment
...Trea...
...5. Procalcitonin...
We recommend that empiric antibiotic t...
...6. In...
...ion to clinical judgment, we recommend th...
...-65 (tool based on confusion, urea...
...7. Treatme...
...d direct admission to an ICU for pati...
...or patients not requiring vasopressors or mec...
...8. Empiric...
...1 g three times daily, or (S, M)620...
...ycycline 100 mg twice daily, or (C, L)6...
...rolide (azithromycin 500 mg on first day...
...therapy: Amoxicillin/clavulanate 50...
or doxycycline 100 mg twice daily, or (C, L)...
Monotherapy: Respiratory fluoroq...
...9...
...ation therapy with a beta-lactam (ampic...
...with a respiratory fluoroquinolone (levo...
...ion for adults with CAP who have contraindica...
...a-lactam plus a macrolide; or (S, M)620...
...a-lactam plus a respiratory fluoroquinolone. (S, M...
...1...
...suggest NOT routinely adding anaerobic...
...11....
...e recommend abandoning use of the prior cate...
...recommend clinicians cover empirically only for M...
...clinicians are currently covering...
...12. Ster...
...mend NOT routinely using corticosteroids in adults...
...gest NOT routinely using corticosteroids in adu...
...routinely using corticosteroids in adult...
...se the Surviving Sepsis Campaign recommendations...
...13. Antivirals...
...mmend that anti-influenza treatment, suc...
...uggest that anti-influenza treatment...
...14. Antibiot...
...hat standard antibacterial treatment be initia...
...15. Treatment Dura...
...ecommend that the duration of antibiotic th...
...16. Fol...
...dults with CAP whose symptoms have r...
...1. 2007 IDSA/ATS Criteria for Defining...
...al Treatment Strategies for Outpatients with...
...nitial Treatment Strategies for Inpatients w...