From the Guidelines
Community-Acquired Pneumonia (CAP) treatment typically involves antibiotics, with the specific choice depending on the severity of illness, pathogen probabilities, and patient comorbidities 1.
Treatment Guidelines
- For outpatients, a macrolide, doxycycline, or fluoroquinolone with enhanced activity against S. pneumoniae is recommended 1.
- For hospitalized patients, a fluoroquinolone alone or an extended-spectrum cephalosporin (cefotaxime or ceftriaxone) plus a macrolide is suggested 1.
- Patients in the intensive care unit (ICU) should receive ceftriaxone, cefotaxime, ampicillin-sulbactam, or piperacillin-tazobactam in combination with a fluoroquinolone or macrolide 1.
Key Considerations
- Antibiotic selection should be based on severity of illness, pathogen probabilities, resistance patterns of S. pneumoniae, and comorbid conditions 1.
- Intravenous antibiotics may be switched to oral agents when the patient is improving clinically, is hemodynamically stable, and is able to ingest drugs 1.
- Guideline adherence for empiric antibiotic therapy has been shown to reduce mortality in CAP 1.
Additional Recommendations
- The Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) have developed unified guidelines for the management of CAP, which provide a consensus-based approach to treatment 1.
- Other guidelines, such as those from the Canadian Community-Acquired Pneumonia Working Group and the British Thoracic Society, also provide recommendations for antibiotic treatment of CAP 1.
From the Research
Treatment of Community-Acquired Pneumonia (CAP)
The treatment of CAP involves several factors, including:
- Risk stratification of patients by severity 2
- Proper place of therapy, such as outpatient, inpatient, or ICU admission 2, 3
- Choice of appropriate antibiotics, taking into account the patient's risk factors, underlying diseases, and local drug-resistance epidemiology 3, 4
- Consideration of adjunctive therapies, such as corticoids, to improve outcomes in patients with severe CAP 2
Antibiotic Therapy
The choice of antibiotic therapy for CAP is crucial, with options including:
- Empirical antimicrobial regimens, such as macrolides 2
- New antibiotics with direct agent-specific properties, which can help avoid the overuse of broad-spectrum antibiotics 4, 5
- Combination therapies, which may be useful in treating multidrug-resistant pathogens 4
- Narrow-spectrum antibiotics, which are recommended to improve patient prognosis and reduce antibiotic resistance 4
Management and Guidelines
Effective management of CAP requires:
- Awareness of local drug-resistance epidemiology and individual patient characteristics 3
- Adoption of guidelines for CAP management, which can result in significant reductions in mortality, hospitalization, and costs 3, 6
- Implementation of quality improvement projects to improve guideline adherence and patient outcomes 6
- Consideration of severity scores, such as CURB-65, to guide treatment decisions 6