The Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) issued updated clinical practice guidelines for community-acquired pneumonia (CAP).

Community-acquired pneumonia (CAP), an infection of the lung parenchyma that occurs in persons outside of a hospital setting, is associated with high morbidity and mortality.

Diagnosis

Diagnosis of pneumonia is suspected mainly on the basis of clinical presentation.

Gram stain and sputum culture

Routine sputum culture and Gram stain are not recommended in adult outpatients with community-acquired pneumonia (CAP).

Blood culture

·        Blood cultures are not recommended in adult outpatients with CAP.

Influenza testing

If influenza is circulating in the community, influenza testing in adults with CAP is recommended with a rapid influenza molecular assay, which is preferred over a rapid influenza diagnostic test.

Procalcitonin testing

Empiric antibiotic therapy is recommended in adults with clinically suspected and radiographically confirmed CAP, regardless of the patient’s initial serum procalcitonin level.

Empirical Antibiotic Treatment

Outpatient antibiotic regimens

The following antibiotics are recommended in adult patients with CAP who are otherwise healthy:

• Amoxicillin 1 g three times daily OR
• Doxycycline 100 mg twice daily OR
• In areas with pneumococcal resistance to macrolides < 25%: a macrolide (azithromycin 500 mg on day one and then 250 mg daily or clarithromycin 500 mg twice daily or clarithromycin extended-release 1,000 mg daily)

In outpatient adults with CAP who have comorbidities, the following antibiotic regimens are recommended:

• Combination therapy:
• Amoxicillin/clavulanate 500 mg/125 mg 3 times daily OR amoxicillin/clavulanate 875 mg/125 mg twice daily OR 2,000 mg/125 mg twice daily OR a cephalosporin (cefpodoxime 200 mg twice daily or cefuroxime 500 mg twice daily) PLUS
• A macrolide (azithromycin 500 mg on day one then 250 mg daily, clarithromycin [500 mg twice daily or extended release 1,000 mg once daily]) or doxycycline 100 mg twice daily OR

• Monotherapy: Respiratory fluoroquinolone (levofloxacin 750 mg daily, moxifloxacin 400 mg daily, or gemifloxacin 320 mg daily)

Antibacterial therapy in patients with influenza

Standard antibacterial treatment should be initially prescribed to adults with clinical and radiographic evidence of CAP who test positive for influenza.

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