Empiric Treatment
- Antibiotic therapy is typically begun on an empiric basis, since the causative organism is not identified in an appreciable proportion of cases of CAP treated in the outpatient setting
- The clinical features and chest radiographic findings are not sufficiently specific to determine etiology and influence treatment decisions.
- Antibiotics should be started as soon as possible once the diagnosis of CAP is established
Common Pathogens
- most frequently isolated pathogens are S. pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, and respiratory viruses (eg, influenza, parainfluenza, respiratory syncytial virus)
- Legionella pneumoniae and Haemophilus influenzae are less common
- CAP due to S. aureus, Enterobacteriaceae, and Pseudomonas aeruginosa are typically sicker and require admission to the hospital.
Choice of Treatment
- The regimens chosen by the IDSA/ATS guidelines mainly rely on macrolides (with or without a beta-lactam) or newer fluoroquinolones
- The BTS guidelines tend to select older antibiotics than those recommended in North America
IDSA/ATS guidelines
British Thoracic Society
Choice of Antibiotic based on Pathogens
References:
1. www.uptodate.com
2. Guidelines for the Management of
Community Acquired Pneumonia in Adults
Update 2009
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