title: [Updated acute community-acquired pneumonia in adults: Guidelines for initial antimicrobial therapy based on local evidence from the South American Working Group (ConsenSur II)].
abstract: Community-acquired pneumonia (CAP) in adults is probably one of the infections affecting ambulatory patients for which the highest diversity of guidelines has been written worldwide. Most of them agree in that antimicrobial therapy should be initially tailored according to either the severity of the infection or the presence of comorbidities and the etiologic pathogen. Nevertheless, a great variability may be noted among the different countries in the selection of the primary choice in the antimicrobial agents, even for the cases considered as at a low-risk class. This fact may be due to the many microbial causes of CAP and specialties involved, as well as the different health-care systems effecting on the availability or cost of antibiotics. However, many countries or regions adopt some of the guidelines or design their own recommendations regardless of the local data, probably because of the scarcity of such data. This is the reason why we have developed a guideline for the initial treatment of CAP by 2002 upon the basis of several local evidences in South América (ConsenSur I). However, several issues deserve to be currently rediscussed as follows: certain clinical scores other than the Physiological Severity índex (PSI) have become more popular in clinical practice (i.e. CURB-65, CRB-65); some pathogens have emerged in the región, such as community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) and Legionella spp; new evidences on the performance of the rapid test for the etiologic diagnosis in CAP have been reported (eg. urinary Legionella andpneumococcus antigens); new therapeutic considerations needs to be approached (i.e. dosage reformulation, duration of treatment, emergence of novel antibiotics and clinical impact of combined therapy). Like in the first versión of the ConsenSur (ConsenSur I), the various current guidelines have helped to organize and stratify the present proposal, ConsenSur II.
authors.affiliation: Hospital San Martín, Paraná, Argentina. cbantar@arnet.com.ar
authors.forename: Carlos
authors.initials: C
authors.lastname: Bantar
authors.forename: Daniel
authors.initials: D
authors.lastname: Curcio
authors.forename: Abel
authors.initials: A
authors.lastname: Jasovich
authors.forename: Homero
authors.initials: H
authors.lastname: Bagnulo
authors.forename: Alvaro
authors.initials: A
authors.lastname: Arango
authors.forename: Luis
authors.initials: L
authors.lastname: Bavestrello
authors.forename: Angela
authors.initials: A
authors.lastname: Famiglietti
authors.forename: Patricia
authors.initials: P
authors.lastname: García
authors.forename: Gustavo
authors.initials: G
authors.lastname: Lopardo
authors.forename: Miriam
authors.initials: M
authors.lastname: Losanovscky
authors.forename: Ernesto
authors.initials: E
authors.lastname: Martínez
authors.forename: Walter
authors.initials: W
authors.lastname: Pedreira
authors.forename: Luis
authors.initials: L
authors.lastname: Piñeyro
authors.forename: Christian
authors.initials: C
authors.lastname: Remolif
authors.forename: Flavia
authors.initials: F
authors.lastname: Rossi
authors.forename: Fabio
authors.initials: F
authors.lastname: Varón
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D019317:Evidence-Based Medicine; D006801:Humans; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D013020:South America
chemical_list: D000900:Anti-Bacterial Agents