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September 22, 2020 04:00am
By Sallie Rafie, PharmD and Whitney Russell, PharmD student
ATS and IDSA update clinical practice guidelines for community-acquired pneumonia.
About 1 million adults in the United States are hospitalized for pneumonia every year, and 50,000 die from this disease.1
Half of all immunocompetent adults hospitalized for severe pneumonia in the United States are between 18 and 57 years of age).1In the United States, pneumonia is 1 of the top ten most expensive conditions seen during inpatient hospitalizations. In 2013, pneumonia had an aggregate cost of nearly $9.5 billion for 960,000 hospital stays.1
The American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) recently updated clinical practice guidelines previously published in 2007.2The guidelines focus on patients in the United States who are not immunocompromised and have not recently traveled abroad.
Antibiotic recommendations for the treatment of community-acquired pneumonia (CAP) include coverage for the traditional pathogensChlamydia pneumonia, Haemophilus influenza, Legionella, Moraxella catarrhalis, Mycoplasma pneumonia, Staphylococcus aureus,andStreptococcus pneumonia.Widespread use of the pneumococcal conjugate vaccine has caused changes in the microbial etiology of CAP. There has been an increase in other etiologic agents including virusesMethicillin Resistant S. Aureus(MRSA) andPseudomonas aeruginosa.
The following recommendations were published by the ATS and IDSA in October 2019 for the management of CAP:2
Here are antibiotic treatment regimens for CAP in adults in an outpatient setting:2
1. Outpatient adults with comorbidities, such as alcohol; asplenia; chronic heart, lung, liver, or renal disease; or diabetes.
2. Previously healthy adults without comorbidities or risk factors for antibiotic-resistant pathogens:
The evidence-based clinical practice guidelines were published to help clinicians optimize the care for patients with CAP based on new data. Antimicrobial therapy should be based on the presence of comorbidities and local resistance patterns. These recommendations delineate minimum clinical standard of care but were not developed to obviate the need for clinical observation.
Jean Covino, DHSc, MPA, PA-C, is a clinical professor and director of didactic education at the Pace University-Lenox Hill Hospital PA Program-NYC in New York, New York.Jennifer Hofmann, MS, PA-C, is an associate clinical professor at the Pace University-Lenox Hill Hospital PA Program-NYC.