Community-acquired pneumonia (CAP), by definition, is pneumonia acquired outside a hospital. A joint guideline (2019) from the American Thoracic Society/IDSA addresses diagnosis, management and follow-up. The focus of this document is on non-immunocompromised individuals (e.g., those without inherited or acquired immune deficiency or drug-induced neutropenia, those actively receiving cancer chemotherapy, HIV with suppressed CD4 counts or transplant recipients).
Approximately 400,000 hospitalizations from pneumococcal pneumonia occur annually in the US. Pneumococci are responsible for up to 30% of adult CAP, with an incubation period of approximately 1 to 3 days. According the CDC, “the case-fatality rate is 5–7% and may be much higher among elderly persons.” Other bacterial pathogens include Haemophilus influenzae, Mycoplasma pneumoniae, Staphylococcus aureus, Legionella species, Chlamydia pneumoniae, and Moraxella catarrhalis. According the guideline, “The newer multidrug-resistant pathogens, including methicillin-resistant S. aureus (MRSA) and Pseudomonas aeruginosa requires separate treatment options.”
No comorbidities or Risk Factors for MRSA or Pseudomonas aeruginosa
Outpatient with Comorbidities (can be ‘combination therapy’ or ‘monotherapy’ with no order of preference)
Combination Therapy (Amoxicillin/clavulanate or cephalosporin combined with a macrolide or doxycycline)
Note: Comorbidities include: Chronic heart | Lung, liver, or renal disease | Diabetes mellitus | Alcoholism | Malignancy | Asplenia
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