Three Recent Updates in Pneumonia Diagnosis and Management

A shorter course of antibiotics based on clinical stability is safe and
effective for CAP

Clinical Question:
Are shorter courses of antibiotics
based on clinical criteria effective in treating patients with
community-acquired pneumonia?

Bottom Line:
As recommended by guidelines
from the Infectious Diseases Society of America (IDSA) and the American
Thoracic Society (ATS), a minimum of 5 days of antibiotic therapy with
discontinuation of antibiotics based on clinical stability is an
appropriate strategy for the treatment of community-acquired pneumonia
(CAP). (LOE = 1b)

Uranga A, Espana PP, Bilbao A, et al.
Duration of antibiotic treatment in community-acquired pneumonia. JAMA
Intern Med 2016 Jul 25. doi: 10.1001/jamainternmed.2016.363


No surprises in the management of hospitalized patients with CAP
Clinical Question:
What is the best antibiotic strategy to improve
outcomes in patients hospitalized with community-acquired pneumonia?
Bottom Line:
For patients hospitalized with community-acquired pneumonia
(CAP), start antibiotics early, use either fluoroquinolone monotherapy or
beta-lactam/macrolide combination therapy, and switch to oral antibiotics
as soon as patients are hemodynamically stable and can take oral
medications. Although the evidence is mostly of low quality, this review
reaffirms what we already do. (LOE = 2a)

Lee JS, Giesler DL,
Gellad WF, Fine MJ. Antibiotic therapy for adults hospitalized with
community-acquired pneumonia. JAMA 2016;315(6):593-602.

Etiologies of Pneumonia in Hospitalized Patients
NEJM 2015 Jul 30; 373:415
n = 2559 in five hospitals with clinical and radiologic evidence of CAP
Almost all got blood cx, urinary antigen test for S pneumo and L pneumophilia, respiratory virus panel, mycoplasma, C pneumonia.
41% got sputum sample and cx, but only 1/3 high quality
37% acute and convalescent sera for viruses
Pathogen detected in only 38%
 – viruses in 23% (rhinovirus 9%, flu 6%, human metapneumo 4%, RSV 3%)
 – bacterium in 11% (S pneumo 5%)
 – both in 3%
 – fungus or mycobacterium in 1%
Suggests that we’re overusing antibiotics and we need better tests to tell the difference between viral and bacterial.

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