Treatment of community-acquired pneumonia in adults in the outpatient setting
- Thomas M File, Jr, MD
Thomas M File, Jr, MD
- Professor of Medicine
- Northeast Ohio Medical University
Community-acquired pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community, as distinguished from hospital-acquired (nosocomial) pneumonia (HAP). A third category of pneumonia, designated healthcare-associated pneumonia (HCAP), is acquired in other healthcare facilities such as nursing homes, hemodialysis centers, and outpatient clinics. The rationale for this separate designation was that patients with HCAP were at higher risk for multidrug-resistant (MDR) organisms. However, several studies have shown that many patients defined as having HCAP are not at high risk for MDR pathogens [1-3]. Furthermore, although interaction with the healthcare system is potentially a risk for MDR pathogens, underlying patient characteristics are also important independent determinants of risk for MDR pathogens.
CAP is a common and potentially serious illness [4-7]. It is associated with considerable morbidity and mortality, particularly in older adult patients and those with significant comorbidities. (See "Prognosis of community-acquired pneumonia in adults".)
The treatment of CAP in adults in the outpatient setting will be reviewed here. A variety of other important issues related to CAP are discussed separately. These include:
●The diagnostic approach to patients with CAP. (See "Diagnostic approach to community-acquired pneumonia in adults".)
●How one makes the decision to admit patients with CAP to the hospital. (See "Community-acquired pneumonia in adults: Risk stratification and the decision to admit".)
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- INDICATIONS FOR HOSPITALIZATION
- PRINCIPLES OF ANTIMICROBIAL THERAPY
- Establishing the diagnosis
- Empiric therapy
- Common pathogens
- Risk factors for drug resistance
- North America
- United Kingdom
- Coverage of atypical pathogens
- TREATMENT REGIMENS
- No comorbidities, no recent antibiotic use, and low rate of resistance
- Comorbidities, recent antibiotic use, or high rate of resistance
- Pathogen-directed therapy
- Treatment duration and response
- Clinical follow-up
- Follow-up chest radiograph
- The nonresponding patient
- SMOKING CESSATION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS