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10 Severe Community-Acquired Pneumonia

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Step 8: Give antibiotics for adequate duration

Duration of antibiotics should be individualized based on clinical response, type of organisms, biomarker response, development of complications, and comorbidities.

Minimum 5 days of antibiotic is recommended.

Prolonged antibiotics up to 2 weeks should be considered in selected cases such as slow responders, Pseudomonas, and Staphylococcus infection, lung abscess, empyema, and metastatic infection.

Suggested Reading

1.Lim, WS, Baudouin, SV, George, RC, Hill AT, Jamieson C, Le Jeune I, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64(Suppl 3):iii1–55.

British Thoracic Society guidelines give a summary of the initial management of patients admitted to hospital with suspected CAP, the relevant microbiological investigations, and empirical antibiotic choices recommended in patients with CAP.

2.Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 (Suppl 2):S27–72.

Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) guidelines are comprehensive for the treatment of CAP and problems encountered while treating such patients.

3.Niederman MS. Recent advances in community-acquired pneumonia: inpatient and outpatient. Chest. 2007;131(4):1205–15.

This is comprehensive review of recent advances in CAP and HAP.

On the site of care and treatment, the section is organized according to whether one is dealing with outpatients, inpatients, or nursing home patients.

4.Mandell LA, Marrie TJ, Grossman RF, Chow AW, Hyland RH. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. Clin Infect Dis. 2000;31:383.

These guidelines address etiology, diagnosis, and initial management of CAP.

Websites

1.www.guideline.gov/summary

2.www.idsociety.org

3.www.thoracic.org/statements

4.www.uphs.upenn.edu/bugdrug/antibiotic_manual/canadcap.pdf

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