Gordon H. Sun, MD, MS

April 29, 2014

Treating CAP

The 2007 IDSA/American Thoracic Society (IDSA/ATS) Consensus Guidelines[20] are probably the best-known and most respected of existing guidelines on the treatment of adult CAP. This patient was previously healthy, has no reported personal risk factors for drug-resistant S pneumoniae, and is eligible for outpatient therapy. On the basis of the IDSA/ATS guideline, either a macrolide or doxycycline is an acceptable choice for empirical therapy.[20] One exception would be if the patient lived in an area known to have a high prevalence of drug-resistant S pneumoniae, such as the southern United States.[21]

Certain patient comorbidities, such as chronic cardiopulmonary disease, diabetes mellitus, or alcoholism, increase the risk of acquiring pathogens other than S pneumoniae, which is still the most common etiology of CAP.[22] In patients with significant comorbidities who are still eligible for outpatient therapy, a fluoroquinolone or a beta-lactam antibiotic combined with a macrolide may be reasonable options.[20]

Certainly, pneumococcal resistance to macrolides is a well-recognized issue for patients with respiratory tract infections. However, it remains uncertain whether these evolving in vitro resistance patterns have significant clinical implications specifically for patients with CAP.[20]


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