Advances in Antibiotic Therapy for Community-acquired Pneumonia

Diego Viasus; Carolina Garcia-Vidal; Jordi Carratalà

Disclosures

Curr Opin Pulm Med. 2013;19(3):209-215. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Community-acquired pneumonia (CAP) is a major public health problem all over the world. The increasing number of ant`ibiotic-resistant bacteria is a matter of concern for physicians when choosing antibiotic treatment in patients with CAP. This review focuses on the current recommendations of antibiotic treatment, recent information concerning antibiotic resistance of pathogens, and the advances in antibiotic therapy in the field of CAP.

Recent findings A significant increase in the frequency of resistance to the antibiotics commonly used against causative pathogens of CAP, such as β-lactams or macrolides, has been reported in recent years. At present, the prevalence of fluoroquinolone resistance in Streptococcus pneumoniae remains low. Community-acquired methicillin-resistant Staphylococcus aureus and influenza A(H1N1)pdm09 have been reported as causes of severe CAP. Several newly-developed antibiotics, including cepholosporins, ketolides and quinolones, present marked activity in vitro against the main causative pathogens of CAP. Many randomized controlled trials have demonstrated equivalent efficacy of the newer antibiotics compared with conventional antimicrobial therapy in mild-to-moderate CAP.

Summary An increase of resistance to the antibiotics used in CAP has been documented over the years. Several new antibiotics have been developed for treating CAP, with promising results. However, data regarding their efficacy and safety in patients with severe CAP are lacking.

Introduction

Community-acquired pneumonia (CAP) is one of the leading causes of death worldwide and is associated with a high economic burden.[1] Although the mortality rate in patients with CAP was dramatically reduced by the introduction of antibiotics in the 1950s, it has not decreased greatly since that time. Recent studies have shown overall mortality rates of 8–15%;[2,3] however, mortality in patients with CAP who require ICU admission can reach 30%.[4]

Current CAP guidelines recommend stratifying patients into risk groups and selecting appropriate empirical antimicrobial therapy depending on the presence of specific factors.[5–7] In previous studies, guideline-concordant therapy for CAP has been associated with improved health outcomes and reductions in resource use.[8,9] Nonetheless, treatment failures persist and in some cases may be due to the emergence of antimicrobial resistance or new pathogens causing CAP.[10] In this context, the lack of new antibiotics constitutes a major cause for concern.

This review will focus on the current recommendations for antibiotic treatment, recent findings regarding antibiotic resistance among respiratory pathogens, and advances in antibiotic therapy in the field of CAP.

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