Community-acquired pneumonia medical therapy: Difference between revisions
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{{Community-acquired pneumonia}} | {{Community-acquired pneumonia}} | ||
{{CMG}} | |||
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==Overview== | |||
==Empiric Medical Therapy== | |||
==Infectious Diseases Society of America/American Thoracic Society consensus recommendation on empiric antibiotic treatment of community-acquired pneumonia in adults. <ref name="pmid17278083">{{cite journal |author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |month=March |pmid=17278083 |doi=10.1086/511159 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17278083 |accessdate=2012-09-06}}</ref> (DO NOT EDIT)== | |||
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===Previously healthy and no risk factors for drug-resistant Streptococcus pneumoniae=== | |||
* A [[macrolide]] ([[azithromycin]], [[clarithromycin]], or [[erythromycin]] '''(Strong recommendation; level I evidence)''' | |||
* [[Doxycycline]] (Weak recommendation; level III evidence) | |||
===Presence of comorbidities or other risks for drug-resistant Streptococcus pneumoniae=== | |||
Presence of comorbidities, such as chronic heart, lung, liver, or renal disease; [[diabetes mellitus]]; [[alcoholism]]; malignancies; [[asplenia]]; immunosuppressing conditions or use of immunosuppressing drugs; use of antimicrobials within the previous 3 months (in which case an alternative from a different class should be selected); or other risks for DRSP infection: | |||
* A respiratory [[fluoroquinolone]] ([[moxifloxacin]], [[gemifloxacin]], or [[levofloxacin]] [750 mg]) ('''Strong recommendation; level I evidence''') | |||
* A beta-lactam plus a [[macrolide]] (Strong recommendation; level I evidence) (High-dose [[amoxicillin]] [e.g., 1 g 3 times daily] or amoxicillin-clavulanate [2 g 2 times daily] is preferred; alternatives include [[ceftriaxone]], [[cefpodoxime]], and [[cefuroxime]] [500 mg 2 times daily]; [[doxycycline]] (level II evidence) is an alternative to the macrolide.) | |||
===In regions with a high rate (>25%) of infection=== | |||
In regions with a high rate (>25%) of infection with high-level (minimal inhibitory concentration [MIC], >16 micrograms/mL) macrolide-resistant S. pneumoniae, consider the use of alternative agents for any patient, including those without comorbidities. (Moderate recommendation; level III evidence) | |||
====Inpatient, Non-ICU Treatment==== | |||
The following regimens are recommended for hospital ward treatment. | |||
* A respiratory fluoroquinolone (Strong recommendation; level I evidence) | |||
* A beta-lactam plus a macrolide (Strong recommendation; level I evidence) (Preferred beta-lactam agents include cefotaxime, ceftriaxone, and ampicillin; ertapenem for selected patients; with doxycycline (level III evidence) as an alternative to the macrolide. A respiratory fluoroquinolone should be used for penicillin-allergic patients.) | |||
====Inpatient, ICU Treatment==== | |||
The following regimen is the minimal recommended treatment for patients admitted to the ICU. | |||
* A beta-lactam ([[cefotaxime]], [[ceftriaxone]], or [[ampicillin-sulbactam]]) plus either [[azithromycin]] (level II evidence) or a [[fluoroquinolone]] (Strong recommendation; level I evidence) (For penicillin-allergic patients, a respiratory fluoroquinolone and [[aztreonam]] are recommended.) | |||
* For [[Pseudomonas]] infection, use an antipneumococcal, antipseudomonal beta-lactam ([[piperacillin]]-[[tazobactam]], [[cefepime]], [[imipenem]], or [[meropenem]]) plus either [[ciprofloxacin]] or [[levofloxacin]] (750-mg dose) | |||
'''or''' | |||
the above beta-lactam plus an [[aminoglycoside]] and [[azithromycin]] | |||
'''or''' | |||
the above beta-lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone (for penicillin-allergic patients, substitute aztreonam for the above beta-lactam). (Moderate recommendation; level III evidence) | |||
* For community-acquired [[methicillin resistant Staphylococcus aureus]] (CA-MRSA) infection, add [[vancomycin]] or [[linezolid]]. (Moderate recommendation; level III evidence) | |||
}} | |||
'''For Level of evidence classification click [[ACC AHA Guidelines Classification Scheme|here]].''' | |||
==References== | ==References== | ||
Revision as of 14:32, 27 September 2012
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Community-Acquired Pneumonia Microchapters |
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Differentiating Community-acquired pneumonia from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Community-acquired pneumonia medical therapy On the Web |
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American Roentgen Ray Society Images of Community-acquired pneumonia medical therapy |
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Directions to Hospitals Treating Community-acquired pneumonia |
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Risk calculators and risk factors for Community-acquired pneumonia medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Empiric Medical Therapy
Infectious Diseases Society of America/American Thoracic Society consensus recommendation on empiric antibiotic treatment of community-acquired pneumonia in adults. [1] (DO NOT EDIT)
| “ |
Previously healthy and no risk factors for drug-resistant Streptococcus pneumoniae
Presence of comorbidities or other risks for drug-resistant Streptococcus pneumoniaePresence of comorbidities, such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; use of antimicrobials within the previous 3 months (in which case an alternative from a different class should be selected); or other risks for DRSP infection:
In regions with a high rate (>25%) of infectionIn regions with a high rate (>25%) of infection with high-level (minimal inhibitory concentration [MIC], >16 micrograms/mL) macrolide-resistant S. pneumoniae, consider the use of alternative agents for any patient, including those without comorbidities. (Moderate recommendation; level III evidence) Inpatient, Non-ICU TreatmentThe following regimens are recommended for hospital ward treatment.
Inpatient, ICU TreatmentThe following regimen is the minimal recommended treatment for patients admitted to the ICU.
or the above beta-lactam plus an aminoglycoside and azithromycin or the above beta-lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone (for penicillin-allergic patients, substitute aztreonam for the above beta-lactam). (Moderate recommendation; level III evidence)
|
” |
For Level of evidence classification click here.
References
- ↑ Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083. Retrieved 2012-09-06. Unknown parameter
|month=ignored (help)