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
...NOT obtaining sputum Gram stain and...
...d as severe CAP (see Table 1), especially if they...
...g empirically treated for MRSA or P. aerugin...
...iously infected with MRSA or P. aeruginosa, especi...
...hospitalized and received parenteral an...
.... Blood Cultures...
...mmend NOT obtaining blood cultures...
...st NOT routinely obtaining blood cultures in...
1. are classified as severe CAP (se...
...mpirically treated for MRSA or P....
...e previously infected with MRSA or P. aerugino...
...talized and received parenteral antibiotics,...
...inary Antigen...
...NOT routinely testing urine for pneumococcal antig...
...adults with severe CAP. (C, L)620...
...uggest NOT routinely testing urine for...
...in cases where indicated by epidemiological...
...h severe CAP (See Table 1). (C, L)620...
...ng for Legionella urinary antigen...
.... Respiratory Sam...
...en influenza viruses are circulating in the co...
Treatment
...reatmen...
...Procalciton...
...t empiric antibiotic therapy should be in...
...tient Versus Outpatient...
...clinical judgment, we recommend that...
...5 (tool based on confusion, urea level, respi...
...Treatment Intensit...
...commend direct admission to an ICU for patie...
...or patients not requiring vasopress...
...c Antibiotics – Outpatient
...g three times daily, or (S, M)620...
...line 100 mg twice daily, or (C, L...
...(azithromycin 500 mg on first day then 250 mg...
...erapy: Amoxicillin/clavulanate 500...
...xycycline 100 mg twice daily, or (C...
...Respiratory fluoroquinolone (levofloxacin...
9. Empiric Antibiotics – Inpa...
...erapy with a beta-lactam (ampicillin+sulbactam...
...apy with a respiratory fluoroquinolone (l...
...ion for adults with CAP who have contraindicat...
...m plus a macrolide; or (S, M)620...
...m plus a respiratory fluoroquinolone....
...pected Aspiratio...
...ggest NOT routinely adding anaerobic co...
...ended-spectrum Antibio...
...nd abandoning use of the prior categorization of...
...recommend clinicians cover empirical...
...ns are currently covering empirically for MRSA...
.... Steroids
...ecommend NOT routinely using corticost...
...NOT routinely using corticosteroids in adults...
...T routinely using corticosteroids in adults with s...
...the Surviving Sepsis Campaign recommendati...
.... Antiviral...
...mmend that anti-influenza treatment,...
...est that anti-influenza treatment be prescribed...
...ntibiotics for Test-Positive Influenza...
...t standard antibacterial treatment be initially...
.... Treatment Duration...
...that the duration of antibiotic therapy...
...ollow-up X-ray...
...n adults with CAP whose symptoms have resolv...
.... 2007 IDSA/ATS Criteria for Defini...
...ble 2. Initial Treatment Strategies for O...
...ial Treatment Strategies for Inpat...