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
...ram Stain...
...end NOT obtaining sputum Gram stain and cu...
...e classified as severe CAP (see Table 1...
...are being empirically treated for M...
...viously infected with MRSA or P. aeruginosa...
...talized and received parenteral antibioti...
.... Blood Cultur...
...mend NOT obtaining blood cultures in adults with...
...routinely obtaining blood cultures in adults with...
...lassified as severe CAP (see Table...
...ng empirically treated for MRSA or P...
...viously infected with MRSA or P. aeruginosa...
2.c. were hospitalized and received paren...
...nary Antigens...
...st NOT routinely testing urine for pneumococcal an...
...cept in adults with severe CAP. (C, L)620
...st NOT routinely testing urine for Legion...
...ases where indicated by epidemiological fac...
...ults with severe CAP (See Table 1). (C, L...
...ggest testing for Legionella urinary antigen an...
...Respiratory Samp...
...iruses are circulating in the commu...
Treatment
...eatment...
...ocalcitonin...
...hat empiric antibiotic therapy should be initiat...
...ent Versus Outpatient...
...o clinical judgment, we recommend that clinic...
...r the CURB-65 (tool based on confusion,...
...Treatment Intensity...
...recommend direct admission to an ICU for patie...
...ents not requiring vasopressors or mec...
...Empiric Antibiotics – Outpat...
...moxicillin 1 g three times daily,...
...100 mg twice daily, or (C, L)620...
...macrolide (azithromycin 500 mg on...
...n therapy: Amoxicillin/clavulanate 500...
...100 mg twice daily, or (C, L)for combination thera...
...: Respiratory fluoroquinolone (...
...c Antibiotics – Inpatient...
...tion therapy with a beta-lactam (ampicill...
...h a respiratory fluoroquinolone (levofloxaci...
...for adults with CAP who have contr...
...-lactam plus a macrolide; or (S, M)62...
...tam plus a respiratory fluoroquinolone. (S, M)62...
.... Suspected Aspiration
...t NOT routinely adding anaerobic cov...
...ended-spectrum Antibiot...
...mmend abandoning use of the prior categorizatio...
...linicians cover empirically only for...
...are currently covering empirically for MRSA...
...Steroids...
...mend NOT routinely using corticost...
...outinely using corticosteroids in adul...
...e suggest NOT routinely using corticost...
...Surviving Sepsis Campaign recommendatio...
13. Antivi...
...ommend that anti-influenza treatment, s...
...st that anti-influenza treatment be prescr...
...cs for Test-Positive Influenza...
...t standard antibacterial treatment be initial...
...atment Duration...
...recommend that the duration of antibiotic...
.... Follow-up X-ray...
...CAP whose symptoms have resolved withi...
...2007 IDSA/ATS Criteria for Defining Severe CAPHa...
...e 2. Initial Treatment Strategies for O...
...tial Treatment Strategies for Inpa...