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
...agnosi...
.... Gram Stain
...mend NOT obtaining sputum Gram sta...
...ssified as severe CAP (see Table 1), especially...
...a. are being empirically treated for MRSA...
....b. were previously infected with MRSA or P. a...
...ere hospitalized and received parenteral...
...ood Cultures...
...ecommend NOT obtaining blood cultu...
...est NOT routinely obtaining blood cultures in adul...
...are classified as severe CAP (see Table 1)...
.... are being empirically treated for MRSA...
...ously infected with MRSA or P. aeruginosa, espe...
...pitalized and received parenteral an...
...rinary Antigens...
...e suggest NOT routinely testing urin...
...ults with severe CAP. (C, L)620...
...est NOT routinely testing urine for Legionel...
...es where indicated by epidemiological...
...th severe CAP (See Table 1). (C, L)620...
...testing for Legionella urinary antige...
...espiratory Sampling...
...enza viruses are circulating in the commu...
Treatment
...eatment...
5. Procalcit...
We recommend that empiric antibioti...
.... Inpatient Versus Outpatien...
...tion to clinical judgment, we recommend...
...B-65 (tool based on confusion, ure...
...Treatment Intensit...
...direct admission to an ICU for patients with hy...
...patients not requiring vasopressors or m...
...Empiric Antibiotics – Outpat...
Amoxicillin 1 g three times daily, or (...
...ne 100 mg twice daily, or (C, L)620...
...thromycin 500 mg on first day then 25...
...apy: Amoxicillin/clavulanate 500 mg/125 mg thr...
...oxycycline 100 mg twice daily, or (C, L)for c...
...notherapy: Respiratory fluoroqu...
...iric Antibiotics – Inpati...
...tion therapy with a beta-lactam (ampicill...
...th a respiratory fluoroquinolone (levofloxacin...
...hird option for adults with CAP who have contr...
...eta-lactam plus a macrolide; or...
...lactam plus a respiratory fluoroquinolon...
...Suspected Aspirati...
...OT routinely adding anaerobic coverage fo...
...xtended-spectrum Antibiotics...
...commend abandoning use of the prior categorizat...
...clinicians cover empirically only for M...
...clinicians are currently covering...
...Steroid...
...commend NOT routinely using corticoste...
...gest NOT routinely using corticosteroids i...
...outinely using corticosteroids in adults with s...
...se the Surviving Sepsis Campaign recommendations...
.... Antiviral...
...t anti-influenza treatment, such as oselt...
...gest that anti-influenza treatment...
...ics for Test-Positive Influenza...
...at standard antibacterial treatmen...
...eatment Duration...
...at the duration of antibiotic ther...
...6. Follow-up X-ra...
...lts with CAP whose symptoms have resol...
Table 1. 2007 IDSA/ATS Criteria for...
...nitial Treatment Strategies for Outpatients w...
...3. Initial Treatment Strategies for Inpatie...