As the authors of this document lead off, it has been more than 10 years since the last American Thoracic Society/Infectious Diseases Society of America community-acquired pneumonia guideline – and much has changed. And, reflecting this, Much Has Changed.
A few interesting tidbits:
- Do not obtain blood cultures in the outpatient setting, and blood cultures are recommended as inpatients only for severe CAP and when MRSA and P. aeruginosa are being covered. This, of course, is likely moot given our current triage of potential sepsis.
- Basic outpatient CAP should be amoxicillin, doxycycline, or macrolide (based on local resistance) monotherapy. Add in comorbidities, and combination therapy or monotherapy with a respiratory fluoroquinolone is indicated.
- Procalcitonin is not reliable to augment clinical judgment when CAP is suspected.
- The Pneumonia Severity Index is the preferred decision instrument to augment clinical judgement regarding hospitalization.
- Inpatient antibiotics are universally ß-lactam plus macrolide, or monotherapy with a respiratory fluoroquinolone. Empiric MRSA and P. aeruginosa coverage is suggested only if prior infection, not in those with risk factors alone.
- No routine empiric anerobic coverage for suspected aspiration pneumonia.
- No routine steroids for CAP, even severe.
- Various recommendations regarding nfluenza and suspicion of CAP – treat with both antiviral and antibiotic therapy.
- No follow-up chest x-ray documenting resolution of infiltrates is necessary in the outpatient setting if the patient is clinically improved.
Details, doses, and rationale within – many caveats, conditional recommendations, and need for additional research.
“Diagnosis and Treatment of Adults with Community-acquired Pneumonia: An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America”
https://www.atsjournals.org/doi/10.1164/rccm.201908-1581ST