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
...iagnos...
...Gram Stai...
...recommend NOT obtaining sputum Gram sta...
...ssified as severe CAP (see Table 1), especial...
...are being empirically treated for MRSA or P....
...were previously infected with MRSA or P. aeru...
.... were hospitalized and received parentera...
.... Blood Cult...
...commend NOT obtaining blood cultures in adults w...
...NOT routinely obtaining blood cultures in adults...
...e classified as severe CAP (see Table...
...ng empirically treated for MRSA or...
...eviously infected with MRSA or P. aeru...
...hospitalized and received parenteral antibiotics...
3. Urinary Antigen...
We suggest NOT routinely testing urine for...
...dults with severe CAP. (C, L)620...
...OT routinely testing urine for Legionella a...
...in cases where indicated by epidemiological fa...
...h severe CAP (See Table 1). (C, L)620...
...ggest testing for Legionella urinary antigen...
4. Respiratory Samp...
...fluenza viruses are circulating in the co...
Treatment
...atment
.... Procalcitoni...
...end that empiric antibiotic therapy shou...
...nt Versus Outpatient...
...ion to clinical judgment, we recommend...
...CURB-65 (tool based on confusion, u...
...atment Intensity...
...end direct admission to an ICU for patients with...
...ents not requiring vasopressors or mechanical...
8. Empiric Antibiotics – Outp...
...g three times daily, or (S, M)620...
...line 100 mg twice daily, or (C, L)62...
...lide (azithromycin 500 mg on first day t...
...therapy: Amoxicillin/clavulanate 500 mg/12...
...ine 100 mg twice daily, or (C, L)for combin...
...Respiratory fluoroquinolone (levofloxacin 7...
...Empiric Antibiotics – Inpat...
...ination therapy with a beta-lactam (ampicillin+su...
...notherapy with a respiratory fluoroquinolo...
...for adults with CAP who have contrain...
...beta-lactam plus a macrolide; or (S, M)...
...beta-lactam plus a respiratory flu...
...0. Suspected Aspiration...
...gest NOT routinely adding anaerobi...
...Extended-spectrum Antibi...
...d abandoning use of the prior categorization o...
...clinicians cover empirically only for MRSA or...
...clinicians are currently covering e...
...2. Steroi...
...recommend NOT routinely using corticosteroids in a...
...suggest NOT routinely using corticosteroids...
...suggest NOT routinely using corticosteroids...
...urviving Sepsis Campaign recommendations on...
...Antivirals
...mend that anti-influenza treatment, such...
...uggest that anti-influenza treatment be prescri...
...Antibiotics for Test-Positive Influe...
...commend that standard antibacterial treatment be...
...Treatment Durati...
...ommend that the duration of antibiotic ther...
...llow-up X-ray...
...ults with CAP whose symptoms have resolved...
...SA/ATS Criteria for Defining Severe CAP...
...al Treatment Strategies for Outpatients with C...
...3. Initial Treatment Strategies for In...