[Guidelines for management of community-acquired pneumonia in adults].
Community-acquired pneumonia in adults is a common cause of morbidity and mortality particularly in the elderly and in patients with comorbidities. Most episodes are of bacterial origin, Streptococcus pneumoniae is the most frequently isolated pathogen. Epidemiological surveillance provides information about changes in microorganisms and their susceptibility. In recent years there has been an increase in cases caused by community-acquired meticillin resistant Staphylococcus aureus and Legionella sp. The chest radiograph is essential as a diagnostic tool. CURB-65 score and pulse oximetry allow stratifying patients into those who require outpatient care, general hospital room or admission to intensive care unit. Diagnostic studies and empirical antimicrobial therapy are also based on this stratification. The use of biomarkers such as procalcitonin or C-reactive protein is not part of the initial evaluation because its use has not been shown to modify the initial approach. We recommend treatment with amoxicillin for outpatients under 65 year old and without comorbidities, for patients 65 years or more or with comorbidities amoxicillin-clavulanic/sulbactam, for patients hospitalized in general ward ampicillin-sulbactam with or without the addition of clarithromycin, and for patients admitted to intensive care unit ampicillin-sulbactam plus clarithromycin. Suggested treatment duration is 5 to 7 days for outpatients and 7 to 10 for those who are hospitalized. During the influenza season addition of oseltamivir for hospitalized patients and for those with comorbidities is suggested.
Sociedad Argentina de Infectología, Buenos Aires, Argentina. E-mail: glopardo@intramed.net.
Gustavo
G
Lopardo
Adriana
A
Basombrío
Liliana
L
Clara
Javier
J
Desse
Lautaro
L
De Vedia
Eugenia
E
Di Libero
Marcelo
M
Gañete
María José
MJ
López Furst
Analía
A
Mykietiuk
Corina
C
Nemirovsky
Carolina
C
Osuna
Claudia
C
Pensotti
Pablo
P
Scapellato
D000328:Adult; D000368:Aged; D006801:Humans; D008875:Middle Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013296:Streptococcus pneumoniae
D000900:Anti-Bacterial Agents
antibiotics treatment; community-acquired pneumonia