{ "schemaVersion": 2, "eyebrow": "Infectious Diseases", "title": "Community-Acquired Pneumonia Antibiotics", "summary": "Select empiric community-acquired pneumonia therapy by site of care, severity, comorbidity, and validated MRSA or Pseudomonas risk—not by obsolete healthcare-associated pneumonia categories. Obtain targeted microbiology before broad therapy when results can support de-escalation or define treatment duration.", "seoDescription": "Physician guide to empiric antibiotic selection for adult community-acquired pneumonia by setting, severity, comorbidities, and MRSA or Pseudomonas risk.", "clinicalQuestion": "How should empiric antibiotics be selected and reassessed for adults with community-acquired pneumonia?", "specialty": "Infectious Diseases", "audience": "U.S. physicians and medical trainees", "tags": [ "community-acquired pneumonia", "CAP antibiotics", "outpatient pneumonia treatment", "inpatient CAP regimen", "MRSA pneumonia", "Pseudomonas pneumonia", "aspiration pneumonia", "antibiotic duration" ], "keyTakeaways": [ "Use site of care and CAP severity to determine the initial regimen; do not broaden solely because of prior healthcare contact. [14][21]", "For nonsevere inpatient CAP without MRSA or Pseudomonas risk factors, use a beta-lactam plus macrolide or respiratory fluoroquinolone monotherapy. [10][14]", "Reserve empiric MRSA or Pseudomonas coverage for patients with prior respiratory isolation or recent hospitalization with parenteral antibiotics, guided by local epidemiology. [6][7][14]", "Obtain lower-respiratory and blood cultures in severe CAP and when empirically treating MRSA or Pseudomonas; use results to narrow therapy. [7][14]", "Treat uncomplicated CAP for at least 5 days; use 7 days for suspected or proven MRSA or Pseudomonas infection. [19]" ], "sections": [ { "id": "initial-regimen-branch", "eyebrow": "First decision", "heading": "Choose the treatment branch before choosing the drug", "intro": "Antibiotic selection follows site of care, severity, and risk for resistant bacterial pathogens.", "paragraphs": [ "For an adult with a new infiltrate and compatible acute syndrome, determine outpatient versus inpatient care with a validated severity tool plus clinical judgment. CURB-65 assigns one point each for confusion, urea greater than 7 mmol/L, respiratory rate at least 30/min, systolic blood pressure below 90 mm Hg or diastolic pressure 60 mm Hg or less, and age 65 years or older; PSI is also used to stratify outpatient versus hospital care. [11][14]", "Treat suspected CAP empirically for bacterial infection or bacterial coinfection at presentation because no rapid diagnostic test can reliably establish that CAP is exclusively viral at that point. COVID-19 pneumonia may be an exception. [16]", "Separate severe CAP from nonsevere inpatient CAP before selecting therapy. Severe CAP is present with one major criterion or at least three minor criteria under ATS/IDSA criteria; severe disease drives ICU-level assessment, broader microbiologic testing, and selection of a combination regimen rather than routine fluoroquinolone monotherapy. [15][14]" ], "bullets": [ "Do not apply standard CAP empiric regimens without modification to congenital or acquired immune deficiency, drug-induced neutropenia, or other major immunocompromising conditions; these groups were excluded from the ATS/IDSA CAP guideline and merit early infectious diseases input. [18][16]", "Reassess a patient without expected improvement for an uncovered pathogen, inadequate absorption or dose, drug reaction, aspiration or endobronchial obstruction, and complications including parapneumonic effusion, empyema, or lung abscess. [3]" ], "subsections": [], "table": { "caption": "Initial antibiotic-selection framework for adults with CAP. [10][14][16]", "columns": [ "Clinical branch", "Empiric treatment direction", "What changes the next step" ], "rows": [ [ "Outpatient CAP", "Target typical bacterial CAP pathogens; outpatient therapy centers on amoxicillin or doxycycline when no comorbidities are present. [16]", "Comorbidity or validated resistant-pathogen risk increases the need for broader regimen selection. [6][14]" ], [ "Nonsevere inpatient CAP without MRSA or Pseudomonas risk", "Use beta-lactam plus macrolide or respiratory fluoroquinolone monotherapy. [10][14]", "Use culture data and clinical response to narrow or change therapy. [7][14]" ], [ "Severe inpatient CAP", "Use a beta-lactam-based combination regimen; obtain microbiologic testing before antibiotics when feasible without delaying treatment. [7][14][15]", "Add MRSA or antipseudomonal coverage only when validated risk is present. [6][7][14]" ], [ "Suspected aspiration-associated CAP", "Treat according to CAP severity and resistant-pathogen risk. [15][16]", "Add anaerobic coverage only if lung abscess or empyema is suspected. [16]" ] ] } }, { "id": "outpatient-antibiotics", "eyebrow": "Ambulatory care", "heading": "Select outpatient therapy by comorbidity and local resistance", "intro": "Outpatient treatment should provide reliable pneumococcal coverage while avoiding unnecessary broad-spectrum exposure.", "paragraphs": [ "For outpatient adults without comorbidities or resistant-pathogen risk factors, amoxicillin or doxycycline are the principal empiric options described for coverage centered on Streptococcus pneumoniae. Doxycycline also covers atypical organisms and may cover Haemophilus influenzae and Staphylococcus aureus. [16]", "Macrolide monotherapy requires caution because empiric atypical coverage remains debated and resistance can undermine macrolide-only treatment. If a macrolide is selected, anchor the decision to local pneumococcal susceptibility data and patient-specific arrhythmia and drug-interaction risk. [6][14]", "For outpatients with chronic heart, liver, renal, or lung disease; diabetes; alcoholism; asplenia; or malignancy, select a broader regimen consistent with CAP guidance because comorbidity is associated with vulnerability to inadequate empiric therapy and may coexist with risk factors for resistant organisms. [6][15]" ], "bullets": [ "Do not use a history of aspiration alone to automatically add anaerobic therapy; reserve anaerobic coverage for suspected abscess or empyema. [16]", "Escalate from outpatient management when severity assessment, hypoxemia, inability to take oral therapy, hemodynamic instability, altered mental status, or worsening respiratory status makes ambulatory treatment unsafe. [11][15]" ], "subsections": [], "table": { "caption": "Outpatient treatment-selection considerations. [6][14][15][16]", "columns": [ "Patient pattern", "Selection principle", "Avoidable error" ], "rows": [ [ "No listed comorbidity or resistant-pathogen risk", "Use amoxicillin or doxycycline-based outpatient treatment. [16]", "Assuming an antibiotic can be withheld because viral infection is possible at presentation. [16]" ], [ "Listed medical comorbidity", "Use a broader CAP regimen appropriate to comorbidity and local resistance patterns. [6][15]", "Using a narrow regimen without considering risk of inadequate empiric coverage. [6]" ], [ "Aspiration risk without abscess or empyema", "Use standard CAP-directed treatment. [16]", "Routine anaerobic expansion. [16]" ], [ "Prior respiratory MRSA or Pseudomonas isolation, or recent hospitalization with parenteral antibiotics", "Assess for resistant-pathogen coverage and obtain cultures if hospitalized or severe. [6][7][14]", "Treating this as ordinary outpatient CAP without assessing pathogen-specific risk. [6][14]" ] ] } }, { "id": "inpatient-antibiotics", "eyebrow": "Hospital care", "heading": "Use standard inpatient CAP regimens unless MRSA or Pseudomonas risk is validated", "intro": "Standard nonsevere inpatient therapy is narrower than empiric resistant-pathogen therapy.", "paragraphs": [ "For hospitalized adults with nonsevere CAP and no risk factors for MRSA or Pseudomonas aeruginosa, guideline-concordant empiric options are a beta-lactam plus macrolide or respiratory fluoroquinolone monotherapy. [10][14] The selection between these options should account for allergy history, prior antibiotic exposure, adverse-effect risk, local susceptibility patterns, and the ability to transition to oral treatment.", "Use a beta-lactam-based combination regimen for severe CAP rather than default respiratory fluoroquinolone monotherapy. Severe CAP also warrants intensified diagnostic sampling because a microbiologic diagnosis can permit pathogen-directed de-escalation and identify pathogens requiring a longer course. [7][14][15]", "A prior respiratory isolation of MRSA or Pseudomonas aeruginosa is the strongest practical signal to consider empiric pathogen-directed coverage. Recent hospitalization with administration of parenteral antibiotics during the prior 90 days is another key risk factor; local epidemiology should modify this decision. [6][7][14]" ], "bullets": [ "When empirically treating MRSA or Pseudomonas, collect lower-respiratory cultures and blood cultures before antibiotics when feasible; do not delay urgent treatment for sampling. [7][14]", "In severe CAP, obtain respiratory samples particularly when the patient is intubated. [7]", "Do not broaden solely for nonresponse at an arbitrary early time point; first evaluate for inadequate drug exposure, resistant or atypical pathogens, empyema, abscess, aspiration, bronchiectasis, obstruction, or systemic immunodeficiency. [3][4]" ], "subsections": [ { "heading": "Aspiration-associated pneumonia", "paragraphs": [ "Manage community-acquired aspiration pneumonia using the same severity-based CAP framework. Ampicillin/sulbactam, carbapenems, and respiratory fluoroquinolones are described as effective options for many patients, but regimen choice still depends on disease severity and resistant-pathogen risk. [15]", "Do not add dedicated anaerobic coverage for suspected aspiration pneumonia unless lung abscess or empyema is suspected. This restriction limits unnecessary antimicrobial exposure while preserving escalation for necrotizing or suppurative pleuropulmonary infection. [16]" ], "bullets": [] } ], "table": { "caption": "Microbiology and resistant-pathogen decisions in hospitalized CAP. [6][7][14]", "columns": [ "Finding or risk factor", "Immediate action", "Antibiotic implication" ], "rows": [ [ "Severe CAP", "Obtain blood and respiratory cultures; test respiratory specimens for relevant viral pathogens in severe disease. [7][14]", "Use severe-CAP combination therapy and narrow when diagnostic results permit. [7][14]" ], [ "Empiric MRSA therapy planned", "Obtain lower-respiratory and blood cultures before treatment when feasible. [7][14]", "Continue, narrow, or stop MRSA-directed therapy based on microbiology and clinical course. [7][14]" ], [ "Empiric antipseudomonal therapy planned", "Obtain lower-respiratory and blood cultures before treatment when feasible. [7][14]", "Use culture and susceptibility results to de-escalate from broad antipseudomonal treatment. [4][7]" ], [ "Prior respiratory MRSA or Pseudomonas infection", "Treat as a pathogen-specific risk signal rather than a generic healthcare-exposure label. [6][7][14]", "Consider empiric coverage directed at the previously isolated organism. [6][14]" ] ] } }, { "id": "diagnostics-and-deescalation", "eyebrow": "Stewardship", "heading": "Order tests that can change empiric coverage or permit de-escalation", "intro": "Testing is most useful in severe disease and when resistant-pathogen therapy is being considered.", "paragraphs": [ "Use rapid molecular influenza testing rather than antigen-based assays when influenza is circulating in the community; testing can also be considered during low influenza activity. [7][14] In hospitalized patients, consider nucleic acid testing for noninfluenza respiratory viruses when CAP is severe or the patient is immunocompromised. [7]", "Send sputum or lower-respiratory cultures and blood cultures for severe CAP, empiric MRSA treatment, empiric Pseudomonas treatment, or prior respiratory infection with either organism. [7][14] These indications focus testing where an identified pathogen can directly contract or redirect an initially broad regimen.", "Do not use procalcitonin as a stand-alone rule-out test for bacterial CAP or as the sole determinant of hospital disposition. Procalcitonin correlates with CAP severity in observational data, but biomarkers have not been sufficiently evaluated to determine hospitalization decisions. [12][13]" ], "bullets": [ "At approximately 72 hours without improvement, reassess for abscess, empyema, missed resistant or atypical pathogen, antibiotic failure, aspiration, obstructing lesion, or impaired host defenses rather than reflexively extending the original regimen. [3][4]", "When cultures identify a susceptible pathogen and the patient is clinically improving, de-escalate to the narrowest active regimen. [4][7]" ], "subsections": [], "table": { "caption": "Diagnostic testing linked to an antibiotic decision. [7][13][14]", "columns": [ "Test", "Who should receive it", "Result-driven action" ], "rows": [ [ "Blood cultures and lower-respiratory culture", "Severe CAP; empiric MRSA or Pseudomonas therapy; or prior respiratory MRSA or Pseudomonas infection. [7][14]", "Target therapy and de-escalate broad empiric coverage when microbiology is informative. [4][7]" ], [ "Rapid molecular influenza assay", "Suspected CAP during community influenza circulation. [7][14]", "Identify influenza as a contributing pathogen; continue to address possible bacterial coinfection at presentation. [16]" ], [ "Noninfluenza respiratory viral nucleic acid testing", "Hospitalized patient with severe CAP or immunocompromise. [7]", "Clarify viral etiologies in a population with substantial inpatient risk. [7]" ], [ "Procalcitonin", "Adjunctive severity assessment when clinically needed. [12][13]", "Do not use alone to decide hospital admission or exclude bacterial CAP. [13][16]" ] ] } }, { "id": "duration-and-treatment-failure", "eyebrow": "Follow-up", "heading": "Set duration by clinical stability and pathogen-specific complications", "intro": "Shorter courses are appropriate only when the patient has uncomplicated CAP and responds clinically.", "paragraphs": [ "For low-, moderate-, or high-severity uncomplicated CAP, treat for a minimum of 5 days, including when clinical stability is reached earlier. [19] A duration-effect meta-analysis included randomized comparisons of the same agent at the same daily dose across different durations in adult outpatients and non-ICU inpatients, supporting the clinical focus on avoiding unnecessarily prolonged treatment in uncomplicated disease. [24]", "Use 7 days of therapy for proven or suspected MRSA or Pseudomonas aeruginosa CAP. [19] Extend or individualize treatment when there is an infectious complication such as empyema or lung abscess, persistent instability, or a pathogen-directed indication not represented by uncomplicated CAP duration evidence. [3][19]", "At discharge, confirm that oral absorption is reliable and that the selected oral agent retains activity against any recovered pathogen. Persistent fever or dyspnea alone should trigger a focused evaluation for treatment failure or complications rather than automatic broadening or prolonged antibiotics. [3][4]" ], "bullets": [ "Minimum uncomplicated CAP duration: 5 days. [19]", "Suspected or proven MRSA or Pseudomonas CAP duration: 7 days. [19]", "Persistent or recurrent clinical deterioration: evaluate for pleural infection, abscess, resistance, alternative diagnosis, aspiration, obstruction, or impaired host defense. [3][8]" ], "subsections": [], "table": { "caption": "Duration and reassessment rules for CAP antibiotics. [3][4][19]", "columns": [ "Clinical course", "Duration or timing rule", "Required action" ], "rows": [ [ "Uncomplicated CAP with clinical improvement", "Treat for at least 5 days. [19]", "Stop when the minimum duration is complete and the clinical course supports resolution. [19]" ], [ "Suspected or proven MRSA or Pseudomonas CAP", "Treat for 7 days. [19]", "Use culture and susceptibility data to select the narrowest active regimen. [4][7]" ], [ "No meaningful improvement by about 72 hours", "Do not simply extend the initial regimen. [4]", "Investigate abscess, empyema, resistance, inadequate therapy, aspiration, obstruction, and host factors. [3][4]" ], [ "Abscess or empyema suspected", "Duration is not governed by uncomplicated 5-day CAP treatment. [3][19]", "Obtain imaging and pursue source-control evaluation while tailoring antimicrobial therapy. [3]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis", "detail": "bmjopen.bmj.com", "url": "https://bmjopen.bmj.com/content/12/6/e062428", "authors": "bmjopen.bmj.com", "host": "bmjopen.bmj.com" }, { "number": 2, "title": "Clinical and economic burden of community-acquired pneumonia ...", "detail": "thorax.bmj.com", "url": "http://thorax.bmj.com/content/thoraxjnl/early/2010/09/22/thx.2009.129502.full.pdf?thx_2009_129502v2=", "authors": "thorax.bmj.com", "host": "thorax.bmj.com" }, { "number": 3, "title": "Community-acquired pneumonia - Management recommendations | BMJ Best Practice", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-gb/17/management-recommendations", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com" }, { "number": 4, "title": "Adapting global guidelines to local contexts: optimising community ...", "detail": "bmjopenrespres.bmj.com", "url": "https://bmjopenrespres.bmj.com/content/12/1/e003699", "authors": "bmjopenrespres.bmj.com", "host": "bmjopenrespres.bmj.com" }, { "number": 5, "title": "acquired pneumonia in Japan: systematic review and meta- analysis ...", "detail": "bmjopenrespres.bmj.com", "url": "https://bmjopenrespres.bmj.com/content/bmjresp/10/1/e001800.full.pdf", "authors": "bmjopenrespres.bmj.com", "host": "bmjopenrespres.bmj.com" }, { "number": 6, "title": "Community-acquired pneumonia in adults - BMJ Best Practice", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-us/17/management-recommendations", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com" }, { "number": 7, "title": "Community-acquired pneumonia in adults - Diagnosis recommendations | BMJ Best Practice US", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-us/17/diagnosis-recommendations", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com" }, { "number": 8, "title": "Severe community-acquired pneumonia (sCAP) - Thorax", "detail": "thorax.bmj.com", "url": "https://thorax.bmj.com/content/80/8/565", "authors": "thorax.bmj.com", "host": "thorax.bmj.com" }, { "number": 9, "title": "Assessment of T-cell subsets and procalcitonin for diagnosing and ...", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-025-23926-8", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 10, "title": "Comparison of Empiric Antibiotic Treatment Regimens for Hospitalized, Non-severe Community-acquired Pneumonia: A Retrospective, Multicenter Cohort Study - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0149291824000201", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 11, "title": "Risk stratification and prediction value of procalcitonin and clinical severity scores for community-acquired pneumonia in ED - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0735675718302420", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 12, "title": "Procalcitonin and severity of community-acquired pneumonia - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1341321X09706555", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 13, "title": "Risk Prediction With Procalcitonin and Clinical Rules in Community-Acquired Pneumonia - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0196064408000309", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 14, "title": "ATS/IDSA Guidelines for Diagnosis and Treatment of Adults with Community-Acquired Pneumonia", "detail": "www.idsociety.org", "url": "http://www.idsociety.org/practice-guideline/community-acquired-pneumonia-cap-in-adults", "authors": "www.idsociety.org", "host": "www.idsociety.org" }, { "number": 15, "title": "Aspiration Pneumonia - StatPearls - NCBI Bookshelf - NIH", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK470459", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 16, "title": "Optimizing Diagnosis and Management of Community Acquired Pneumonia in the Emergency Department - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11212456", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 17, "title": "Diagnosis and Treatment of Adults with Community-acquired ... - IDSA", "detail": "www.idsociety.org", "url": "https://www.idsociety.org/practice-guideline/community-acquired-pneumonia-cap-in-adults", "authors": "www.idsociety.org", "host": "www.idsociety.org" }, { "number": 18, "title": "Diagnosis and Treatment of Adults with Community- ...", "detail": "www.idsociety.org", "url": "https://www.idsociety.org/globalassets/idsa/practice-guidelines/community-acquired-pneumonia-in-adults/metlay_data_supplement.pdf", "authors": "www.idsociety.org", "host": "www.idsociety.org" }, { "number": 19, "title": "Duration of Antimicrobial Treatment in Adult Patients with Pneumonia: A Narrative Review", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11591184", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 20, "title": "Community-acquired Pneumonia Guideline Recommendations—Impact of a Consensus-based Process versus Systematic Reviews - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8677595", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 21, "title": "Diagnosis and Treatment of Adults with Community-acquired ...", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/31573350", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov" }, { "number": 22, "title": "Infectious Diseases Society of America/American Thoracic ... - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7107997", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 23, "title": "Hospital-Acquired and Ventilator-Associated Pneumonia - IDSA", "detail": "www.idsociety.org", "url": "https://www.idsociety.org/practice-guideline/hap_vap", "authors": "www.idsociety.org", "host": "www.idsociety.org" }, { "number": 24, "title": "Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10040075", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis", "detail": "bmjopen.bmj.com", "url": "https://bmjopen.bmj.com/content/12/6/e062428", "authors": "bmjopen.bmj.com", "host": "bmjopen.bmj.com", "snippet": "Title: Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis\nImage 1Image 2Image 3# Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protoco", "score": 0.62852204 }, { "number": 2, "title": "Clinical and economic burden of community-acquired pneumonia ...", "detail": "thorax.bmj.com", "url": "http://thorax.bmj.com/content/thoraxjnl/early/2010/09/22/thx.2009.129502.full.pdf?thx_2009_129502v2=", "authors": "thorax.bmj.com", "host": "thorax.bmj.com", "snippet": "Antibiotic resistance was seen in all pathogens associated with CAP. There was an increase in antibiotic-resistant strains, but resistance was", "score": 0.9520486003448954 }, { "number": 3, "title": "Community-acquired pneumonia - Management recommendations | BMJ Best Practice", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-gb/17/management-recommendations", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com", "snippet": "Unexpected pathogen or pathogens not covered by antibiotic choice (e.g., ‘atypical’ pathogens, pathogens resistant to commonly used antibiotics such as ampicillin-resistant Haemophilus influenzae)\n\nAntibiotic ineffective or causing allergic reaction (e.g., poor absorption of oral antibiotic, inadequ", "score": 0.9510510507210587 }, { "number": 4, "title": "Adapting global guidelines to local contexts: optimising community ...", "detail": "bmjopenrespres.bmj.com", "url": "https://bmjopenrespres.bmj.com/content/12/1/e003699", "authors": "bmjopenrespres.bmj.com", "host": "bmjopenrespres.bmj.com", "snippet": "(AMS) and context-specific treatment guidelines.20 The absence of antimicrobial stewardship programmes (ASPs) and the suboptimal infection control practices further enhance the AMR burden, reducing the effectiveness of current antibiotic regimens.21–23 Standardised treatment protocols and continuous", "score": 0.943134079705989 }, { "number": 5, "title": "acquired pneumonia in Japan: systematic review and meta- analysis ...", "detail": "bmjopenrespres.bmj.com", "url": "https://bmjopenrespres.bmj.com/content/bmjresp/10/1/e001800.full.pdf", "authors": "bmjopenrespres.bmj.com", "host": "bmjopenrespres.bmj.com", "snippet": "INTRODUCTION Pneumonia, including aspiration pneu-monia, remains a significant cause of death despite advances in medical care and anti-microbial agents.1–3 Inadequate empiric therapy increases the risk of death4 or treat-ment failure5 6 and is one factor that defines the prognosis of pneumonia. In ", "score": 0.9411181875590703 }, { "number": 6, "title": "Community-acquired pneumonia in adults - BMJ Best Practice", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-us/17/management-recommendations", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com", "snippet": "The recommendation to cover atypical pathogens in the empiric antibiotic regimen is debated; however, the recommendation is supported by current data.(#referencePop135)Naucler P, Strålin K. Routine atypical antibiotic coverage is not necessary in hospitalised patients with non-severe community-acqui", "score": 0.9382783924531778 }, { "number": 7, "title": "Community-acquired pneumonia in adults - Diagnosis recommendations | BMJ Best Practice US", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-us/17/diagnosis-recommendations", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com", "snippet": "The ATS recommends nucleic acid-based testing of respiratory samples for viral pathogens other than influenza only in hospitalized patients with suspected CAP who either have severe CAP or are immunocompromised, based upon the reported findings of high inpatient mortality associated with noninfluenz", "score": 0.919090396837757 }, { "number": 8, "title": "Severe community-acquired pneumonia (sCAP) - Thorax", "detail": "thorax.bmj.com", "url": "https://thorax.bmj.com/content/80/8/565", "authors": "thorax.bmj.com", "host": "thorax.bmj.com", "snippet": "Infection control challenges in LMICs worsen sCAP outcomes. Overcrowded healthcare facilities, poor sanitation and limited access to clean water contribute to healthcare-associated infections, including those caused by MDROs.79 93 94 These infections complicate treatment and diminish the effectivene", "score": 0.9183584538805537 }, { "number": 9, "title": "Assessment of T-cell subsets and procalcitonin for diagnosing and ...", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-025-23926-8", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Severe CAP is associated with high healthcare resource use and increased mortality16, 451 (2018).\"). Its diagnosis requires more than clinical signs and includes laboratory, microbiological, and radiological assessments17, 157–162 (2008).\"). According to standard definitions, severe CAP may involve ", "score": 0.62687886 }, { "number": 10, "title": "Comparison of Empiric Antibiotic Treatment Regimens for Hospitalized, Non-severe Community-acquired Pneumonia: A Retrospective, Multicenter Cohort Study - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0149291824000201", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Comparison of Empiric Antibiotic Treatment Regimens for Hospitalized, Non-severe Community-acquired Pneumonia: A Retrospective, Multicenter Cohort Study - ScienceDirect\n# Original Research Comparison of Empiric Antibiotic Treatment Regimens for Hospitalized, Non-severe Community-acquired Pneu", "score": 0.6455898 }, { "number": 11, "title": "Risk stratification and prediction value of procalcitonin and clinical severity scores for community-acquired pneumonia in ED - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0735675718302420", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Risk stratification and prediction value of procalcitonin and clinical severity scores for community-acquired pneumonia in ED - ScienceDirect\n# Original Contribution Risk stratification and prediction value of procalcitonin and clinical severity scores for community-acquired pneumonia in ED. ", "score": 0.65861565 }, { "number": 12, "title": "Procalcitonin and severity of community-acquired pneumonia - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1341321X09706555", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Okimoto et al. investigated 162 CAP patients with different degree of disease severity, and reported that PCT was positive in 12.8% of the patients with mild disease, 27.1% of those with moderate disease, 59.5% of the patients with severe disease, and 80.0% of those with super severe disease. The mo", "score": 0.62742686 }, { "number": 13, "title": "Risk Prediction With Procalcitonin and Clinical Rules in Community-Acquired Pneumonia - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0196064408000309", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Pediatr Crit Care Med\n\n### Bacteremic elder emergency department patients: procalcitonin and white count\n\n### Acad Emerg Med\n\n### Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis\n\n### Crit Care Med\n\n## Cited", "score": 0.59880555 }, { "number": 14, "title": "ATS/IDSA Guidelines for Diagnosis and Treatment of Adults with Community-Acquired Pneumonia", "detail": "www.idsociety.org", "url": "http://www.idsociety.org/practice-guideline/community-acquired-pneumonia-cap-in-adults", "authors": "www.idsociety.org", "host": "www.idsociety.org", "snippet": "Joshua P. Metlay, Grant W. Waterer, Ann C. Long, Antonio Anzueto, Jan Brozek, Kristina Crothers, Laura A. Cooley, Nathan C. Dean, Michael J. Fine, Scott A. Flanders, Marie R. Griffin, Mark L. Metersky, Daniel M. Musher, Marcos I. Restrepo, and Cynthia G. Whitney; on behalf of the American Thoracic S", "score": 0.79769903 }, { "number": 15, "title": "Aspiration Pneumonia - StatPearls - NCBI Bookshelf - NIH", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK470459", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Ampicillin/sulbactam, carbapenems, or respiratory fluoroquinolones (such as levofloxacin or moxifloxacin) are effective for most patients with community-acquired aspiration pneumonia.(#article-17897.r6) According to the 2019 ATS/IDSA guidelines, for adults without severe pneumonia, significant comor", "score": 0.7756902 }, { "number": 16, "title": "Optimizing Diagnosis and Management of Community Acquired Pneumonia in the Emergency Department - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11212456", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "The IDSA/ATS guidelines state, and ACEP agrees, “there is no current diagnostic test accurate enough or fast enough to determine that CAP is solely due to a virus at presentation, our recommendations are to initially treat empirically for possible bacterial infection or coinfection.”4 Thus, empiric ", "score": 0.77548623 }, { "number": 17, "title": "Diagnosis and Treatment of Adults with Community-acquired ... - IDSA", "detail": "www.idsociety.org", "url": "https://www.idsociety.org/practice-guideline/community-acquired-pneumonia-cap-in-adults", "authors": "www.idsociety.org", "host": "www.idsociety.org", "snippet": "Joshua P. Metlay, Grant W. Waterer, Ann C. Long, Antonio Anzueto, Jan Brozek, Kristina Crothers, Laura A. Cooley, Nathan C. Dean, Michael J. Fine, Scott A. Flanders, Marie R. Griffin, Mark L. Metersky, Daniel M. Musher, Marcos I. Restrepo, and Cynthia G. Whitney; on behalf of the American Thoracic S", "score": 0.77179235 }, { "number": 18, "title": "Diagnosis and Treatment of Adults with Community- ...", "detail": "www.idsociety.org", "url": "https://www.idsociety.org/globalassets/idsa/practice-guidelines/community-acquired-pneumonia-in-adults/metlay_data_supplement.pdf", "authors": "www.idsociety.org", "host": "www.idsociety.org", "snippet": "E54 Supplementary Text on etiology of pneumonia Pneumonia is generally defined as a newly recognized pulmonary infiltrate, together with two or more of the following symptoms: new or increased cough, sputum production, shortness of breath, pleuritic chest pain, confusion, fever, rales, and leukocyto", "score": 0.77179235 }, { "number": 19, "title": "Duration of Antimicrobial Treatment in Adult Patients with Pneumonia: A Narrative Review", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11591184", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "In 2019, the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) updated their previous guidelines and provided evidence-based recommendations for the treatment of CAP in adults who have not recently traveled abroad and do not have an immunocompromising condition. Base", "score": 0.7653308 }, { "number": 20, "title": "Community-acquired Pneumonia Guideline Recommendations—Impact of a Consensus-based Process versus Systematic Reviews - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8677595", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "The American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) Diagnosis and Treatment of Adults with Community-acquired Pneumonia (CAP) guidelines were developed using systematic reviews to inform every recommendation , as suggested by the Institute of Medicine (IOM) Standards fo", "score": 0.72884524 }, { "number": 21, "title": "Diagnosis and Treatment of Adults with Community-acquired ...", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/31573350", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov", "snippet": "Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, ", "score": 0.72395444 }, { "number": 22, "title": "Infectious Diseases Society of America/American Thoracic ... - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7107997", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "The committee wishes to express its gratitude to Robert Balk, Christian Brun-Buisson, Ali El-Sohl, Alan Fein, Donald E. Low, Constantine Manthous, Thomas J. Marrie, Joseph F. Plouffe, and David A. Talan, for their thoughtful review of an earlier version of the guidelines.Supplement sponsorship.This ", "score": 0.70263255 }, { "number": 23, "title": "Hospital-Acquired and Ventilator-Associated Pneumonia - IDSA", "detail": "www.idsociety.org", "url": "https://www.idsociety.org/practice-guideline/hap_vap", "authors": "www.idsociety.org", "host": "www.idsociety.org", "snippet": "The IDSA and ATS each elected one co-chair to lead the guideline panel. Dr Andre Kalil was elected to represent the IDSA and Dr Mark Metersky was elected to represent the ATS. A total of 18 subject-matter experts comprised the full panel, which included specialists in infectious diseases, pulmonary ", "score": 0.64826655 }, { "number": 24, "title": "Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10040075", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "### Eligibility criteria\n\nAll randomised controlled trials comparing the same antibiotics used at the same daily dosage but for different durations for CAP in adults. Both outpatients and inpatients were included but not those admitted to intensive care units. We imposed no date, language or publica", "score": 0.6350646 } ], "publishedAt": "2026-09-15T22:02:35.207592+00:00", "updatedAt": "2026-09-15T22:02:35.207592+00:00", "readingMinutes": 5, "slug": "community-acquired-pneumonia-antibiotics" }