Community Acquired Pneumonia CAP

CAP results in more than 10 million visits to physicians, 64 million days of limited activity, and more than 600,000 hospitalizations annually in the United States (47,48). Most patients with CAP are treated as outpatients with oral antibiotics. This group has a mortality of about 1%, which is a considerably better prognosis than for the elderly or for those who are admitted to the hospital or the intensive care unit for whom mortality rates may range from 12% to 29%. CAP is a major cause of morbidity and mortality (47,48). Mild infections can be managed in the community with oral antibiotics. Patients with more serious infections, as manifest by the pulmonary severity index, may require hospitalization and treatment with intravenous antibiotics or admission to a critical care unit with assisted ventilation.

There is a wide spectrum of individuals with special risk factors and exposure to a variety of pathogens. S. pneumoniae is the most common bacterial pathogen isolated and other common bacterial pathogens include H. influenzae, M. catarrhalis, and S. aureus. There are also atypical pathogens that include Legionella pneumophila, Chlamydia pneumoniae, and Mycoplasma pneumoniae, which may occur alone or in combination with the more "typical" bacterial pathogens, listed above. Antibiotic and MDR pathogens of note include S. pneumoniae and more recently community-acquired MRSA (21,49). Unfortunately, no bacterial pathogen can be identified in 30% to 40% of CAP patients, impeding evaluation of clinical eradication and clinical efficacy difficult.

Guidelines for the Management of CAP were published by IDSA and the American Thoracic Society (ATS) in 2007 (48). Outpatient therapy for reasonably healthy adults includes doxycycline, an oral macrolide (azithromycin or clari-thromycin), or a ketolide or a fluoroquinolone, such as levofloxacin, moxifloxacin, or gemifloxacin. By comparison, patients admitted to the hospital with CAP may be treated with either levofloxacin or ceftriaxone and azithromycin. Those patients admitted to the ICU should have their antibiotics expanded to include an antipseudomonal cephalosporin, carbapenem or beta-lactam-beta-lactamase inhibitor combination, plus vancomycin or linezolid, if MRSA is suspected.

0 0

Post a comment