title: Guidelines for empiric antimicrobial prescribing in community-acquired pneumonia.
abstract: 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.
authors.affiliation: Northeastern Ohio Universities College of Medicine, Rootstown, OH, USA. filet@summa-health.org
authors.forename: Thomas M
authors.initials: TM
authors.lastname: File
authors.forename: Javier
authors.initials: J
authors.lastname: Garau
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.forename: Christian
authors.initials: C
authors.lastname: Chidiac
authors.forename: Keith
authors.initials: K
authors.lastname: Klugman
authors.forename: Hartmut
authors.initials: H
authors.lastname: Lode
authors.forename: John R
authors.initials: JR
authors.lastname: Lonks
authors.forename: Lionel
authors.initials: L
authors.lastname: Mandell
authors.forename: Julio
authors.initials: J
authors.lastname: Ramirez
authors.forename: Victor
authors.initials: V
authors.lastname: Yu
mesh_terms: 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
chemical_list: D024841:Fluoroquinolones; D007769:Lactams; D018942:Macrolides