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Friday, May 22, 2015

Choice of antibiotics for CAP in outpatient

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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