Guidelines for empiric antimicrobial prescribing in community-acquired pneumonia.
Empiric antimicrobial prescribing for community-acquired pneumonia remains a challenge, despite the availability of treatment guidelines. A number of key differences exist between North American and European guidelines, mainly in the outpatient setting. The North American approach is to use initial antimicrobial therapy, which provides coverage for Streptococcus pneumoniae plus atypical pathogens. Europeans tend to focus on providing pneumococcal coverage with less emphasis on covering for an atypical pathogen. Ambulatory patients without comorbidity are more likely to receive macrolide therapy in North America, whereas in Europe these patients would probably receive a beta-lactam agent. Major issues that are fundamental to this difference include the importance of providing therapy for atypical pathogens and the clinical significance of macrolide-resistant S pneumoniae. Prospective data are required to evaluate which of these two approaches offers clinical superiority.
File
Thomas M
TM
Northeastern Ohio Universities College of Medicine, Rootstown, OH, USA. filet@summa-health.org
Garau
Javier
J
Blasi
Francesco
F
Chidiac
Christian
C
Klugman
Keith
K
Lode
Hartmut
H
Lonks
John R
JR
Mandell
Lionel
L
Ramirez
Julio
J
Yu
Victor
V
D002170:Canada; D017714:Community-Acquired Infections / Q000188:drug therapy; D024881:Drug Resistance, Bacterial; D005060:Europe; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D007769:Lactams / Q000627:therapeutic use; D018942:Macrolides / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D014481:United States
D024841:Fluoroquinolones; D007769:Lactams; D018942:Macrolides