In an updated official clinical practice guideline from the American Thoracic Society and Infectious Diseases Society of America, published in the Oct. 1 issue of the American Journal of Respiratory and Critical Care Medicine, recommendations are presented for the diagnosis and management of community-acquired pneumonia (CAP).
Joshua P. Metlay, M.D., Ph.D., from Massachusetts General Hospital in Boston, and colleagues conducted systematic reviews of the relevant research to update clinical practice guidelines on the management of adult patients with CAP.
The authors developed recommendations relating to 16 specific areas, including diagnostic testing, selection of initial antibiotic therapy, and subsequent management. For adults with CAP, Gram stain and culture of lower respiratory secretions should not be obtained routinely in adults managed in the outpatient setting; Gram stain and culture of respiratory secretions should be obtained pretreatment for specific adults, including those classified as having severe CAP. Blood cultures should not be obtained for adults with CAP managed in the outpatient setting but should be obtained for specific adults managed in the hospital setting, including those with severe CAP. For healthy outpatient adults without specific comorbidities or risk factors for antibiotic-resistant pathogens, the recommended antibiotics include amoxicillin 1 g three times daily, doxycycline 100 mg twice daily, or a macrolide only in areas with pneumococcal resistance to macrolides <25 percent.
“The recommendations included here do not obviate the need for clinical assessment and knowledge to ensure each individual patient receives appropriate and timely care,” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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