Azithromycin, a macrolide approved for the treatment of mild pneumonia, offers the potential advantages of short-course administration and better tolerability, compared with other macrolides [9, 10].
What are the FDA-approved antibiotics for community-acquired bacterial pneumonia?
Jul 06, 2018 · Most outpatients with community acquired pneumonia are treated with azithromycin (or another macrolide antibiotic) as this drug gives a simple treatment regimen (single drug, simple dosing, short course). However, the efficacy of this regimen has been questioned in recent years due to increasing macrolide resistance.
What are the treatment options for community-acquired pneumonia (CAP)?
Jul 20, 2010 · The Infectious Diseases Society of America/American Thoracic Society guidelines suggest therapy with a β-lactam antibiotic, with the addition of either a macrolide or fluoroquinolone antibiotic [ 4 ], whilst the British Thoracic Society recommends initiating a β-lactam/macrolide antibiotic combination [ 5 ].
Are macrolides effective in the treatment of Streptococcus pneumoniae?
Mar 01, 2022 · The CDC and others recommend outpatient oral empirical antibiotics with a macrolide, doxycycline, or an oral betalactam (amoxicillin, cefuroxime [Ceftin], or amoxicillin/clavulanate [Augmentin ...
Which medications are used in the treatment of severe pneumonia?
Background: Therapy directed against atypical pathogens in patients with community-acquired pneumonia (CAP) is often recommended. This post-hoc analysis evaluated the effect of addition of a macrolide to ceftaroline fosamil or ceftriaxone treatment in atypical CAP. Methods: Two phase 3, double-blind, comparative safety and efficacy studies of ceftaroline fosamil vs. …
Which macrolide is best for pneumonia?
Which drug is the best choice for monotherapy treatment of community-acquired pneumonia CAP?
Why is azithromycin used in CAP?
Is azithromycin used for community-acquired pneumonia?
Which antibiotics are macrolides?
Is doxycycline a macrolide?
What antibiotics treat community-acquired pneumonia?
What type of pneumonia is treated with azithromycin?
Can you take azithromycin and doxycycline together for pneumonia?
Why is ceftriaxone and azithromycin used together?
What is the best antibiotic to treat pneumonia?
Can amoxicillin and doxycycline be taken together?
What are the goals of pharmacotherapy for CAP?
The primary goals of pharmacotherapy for patients with CAP include eradicating the causative pathogens, resolving the clinical signs and symptoms, minimizing hospitalization, and preventing reinfection. 23 – 27 Physicians should choose a medication based on the pharmacokinetic profile, adverse reactions, drug interactions, and cost-effectiveness. 23 – 27 Further, patient evaluation should focus on severity of illness, patient age, comorbidities, clinical presentation, epidemiologic setting, and previous exposure. 9 The majority of patients with CAP are treated empirically based on the most common pathogen (s) associated with the condition. 23 – 27
What are the tests for pneumonia?
Historically, common laboratory tests for pneumonia have included leukocyte count, sputum Gram stain, two sets of blood cultures, and urine antigens. However, the validity of these tests has recently been questioned after low positive culture rates were found (e.g., culture isolates of S. pneumoniae were present in only 40 to 50 percent of cases). 9 Such low positive culture rates are likely due to problems with retrieving samples from the lower respiratory tract, previous administration of antibiotics, contamination from the upper airways, faulty separation of sputum from saliva when streaking slides or plates, 9 or viral etiology. Furthermore, sputum samples are adequate in only 52.3 percent of patients with CAP, and only 44 percent of those samples contain pathogens. 10 Nonetheless, initial therapy often is guided by the assumption that the presenting disease is caused by a common bacterial pathogen.
What is pneumonia in lungs?
Pneumonia is an inflammation or infection of the lungs that causes them to function abnormally. Pneumonia can be classified as typical or atypical, although the clinical presentations are often similar. Several symptoms commonly present in patients with pneumonia.
What is a chest radiograph for pneumonia?
Chest radiography (posteroanterior and lateral views) has been shown to be a critical component in diagnosing pneumonia. 8 According to the latest American Thoracic Society (ATS) guidelines for the diagnosis and treatment of adults with CAP, “all patients with suspected CAP should have a chest radiograph to establish the diagnosis and identify complications (pleural effusion, multilobar disease).” 8 Chest radiography may reveal a lobar consolidation, which is common in typical pneumonia; or it could show bilateral, more diffuse infiltrates than those commonly seen in atypical pneumonia. However, chest radiography performed early in the course of the disease could be negative.
What is CAP in healthcare?
Community-acquired pneumonia (CAP) is defined as pneumonia not acquired in a hospital or a long-term care facility.
When should fluoroquinolones be used?
Respiratory fluoroquinolones should be used when patients have failed first-line regimens, have significant comorbidities, have had recent antibiotic therapy, are allergic to alternative agents, or have a documented infection with highly drug-resistant pneumococci. C. 8, 9, 28, 29.
What percent of CAP cases are fatal?
S. pneumoniae, which accounts for 60 to 70 percent of all bacterial CAP cases, can affect all patient groups and can cause a fatal form of CAP. The alarming rate of resistance to many commonly used antibiotics raises great concern. Penicillin-resistant S. pneumoniae was uncommon in the early 1990s but has since become increasingly prevalent. 29, 31
Where was the CAP-START study performed?
The Community-Acquired Pneumonia — Study on the Initial Treatment with Antibiotics of Lower Respiratory Tract Infections (CAP-START) was performed in seven hospitals in the Netherlands, from February 2011 through August 2013 (see the Supplementary Appendix, available with the full text of this article at NEJM.org). The design and rationale of the study have been described elsewhere, 18 and the data are reported in accordance with Consolidated Standards of Reporting Trials (CONSORT) statements for cluster-randomized and noninferiority studies. 19,20 Additional study details are provided in the study protocol and statistical analysis plan, which are available at NEJM.org. The study protocol was approved by the ethics review board at the University Medical Center Utrecht (reference number 10/148), by the local institutional review boards, and by the antibiotic committee at each participating hospital.
What is CAP in healthcare?
Introduction. Community-acquired pneumonia (CAP) is a leading cause of hospitalization and death worldwide. 1-3 Most guidelines recommend that antibiotic treatment be based on the severity of disease at presentation, assessed either on the basis of the level of care needed or on the basis of a prognostic risk score.
Can you take corticosteroids for pneumonia?
Corticosteroids should not be routinely prescribed for patients with CAP or severe influenzal pneumonia. Although two studies showed significant improvements in outcomes when corticosteroids were prescribed for CAP, these results are questionable because of study flaws, and subsequent studies have not shown improvement in clinically relevant outcomes.
Can procalcitonin be used to detect pneumonia?
Several studies have evaluated whether the serum procalcitonin level can be used to distinguish bacterial pneumonia from viral infections. Because its sensitivity to detect bacterial infection ranges from 38% to 91%, the procalcitonin level is not accurate enough to justify withholding antibiotics in patients with suspected CAP.
Does sputum culture help with CAP?
Routine blood and sputum cultures have not been shown to improve patient outcomes in CAP. Sputum cultures are recommended before treatment initiation only if the patient has severe CAP, and particularly if he or she is intubated; if the patient has a history of methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa infection or if he or she is being empirically treated for these pathogens; or if the patient was hospitalized and received parenteral antibiotics within the previous 90 days. Lower respiratory tract samples from intubated patients with severe CAP should be sent for Gram stain and culture soon after intubation because of the higher risk of MRSA or P. aeruginosa infection, and because endotracheal aspirates have a higher yield than sputum samples. Blood cultures should be obtained if the patient has severe CAP; was previously or is currently being treated empirically for MRSA or P. aeruginosa infection, particularly respiratory infections; or if the patient was hospitalized and received parenteral antibiotics within the previous 90 days. The yield of blood cultures is low (2% to 9%) in adults without severe CAP, and empiric therapy is rarely changed based on these results.
Can you test for Legionella in urine?
Urinary antigen testing for Legionella or pneumococcus has not been shown to improve outcomes. Based on low-quality evidence, the ATS/IDSA guideline suggests that routine urine testing for pneumococcal antigen be performed only in severe cases of CAP and that urine testing for Legionella antigen be performed only in cases of severe CAP, exposure to a Legionella outbreak, or travel to an endemic area.
When should blood cultures be obtained?
Blood cultures should be obtained if the patient has severe CAP; was previously or is currently being treated empirically for MRSA or P. aeruginosa infection, particularly respiratory infections; or if the patient was hospitalized and received parenteral antibiotics within the previous 90 days.
How long should you take antibiotics for CAP?
The recommended duration of antibiotic therapy has not changed from previously published guidelines. Patients with CAP should be treated for a minimum of 5 days, with antibiotic therapy continued until the patient achieves clinical stability.
What is CAP in pharmacy?
Community-acquired pneumonia (CAP), an infection of the lung parenchyma that occurs in persons outside ...
What is CAP in healthcare?
ABSTRACT: In 2019, guidelines for the management of immunocompetent adults with community-acquired pneumonia (CAP) were published jointly by the American Thoracic Society and the Infectious Diseases Society of America. Different treatment regimens are recommended depending on whether the patient is receiving treatment in ...
What are the causes of CAP?
The most common bacterial causes of CAP are Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Staphylococcus aureus, Legionella species, Chlamydia pneumoniae, and Moraxella catarrhalis. Although viral pathogens are becoming an increasingly common cause of CAP, the new guidelines recommend that all patients with CAP be treated empirically for bacterial infection. The basis for this recommendation is that no rapid and specific diagnostic test exists to confirm that a patient’s illness is due solely to a virus at the time of presentation, and patients with CAP caused by a virus often have a bacterial coinfection. Notably, the guidelines have eliminated the term healthcare-associated pneumonia, instead emphasizing the use of local epidemiology and risk factors to determine the need for coverage of drug-resistant pathogens, such as methicillin-resistant S aureus (MRSA) and Pseudomonas aeruginosa. 4
What are the risk factors for MRSA?
Risk factors for MRSA and P aeruginosa include prior respiratory isolation of the pathogen or hospitalization with receipt of parenteral antibiotics within the past 90 days , with locally validated risk factors for these pathogens. According to the guidelines, the process of local validation involves obtaining local data on the prevalence ...
Do pharmacists work with physicians?
Pharmacists should actively work with physicians in both the inpatient and outpatient setting to ensure that patients with pneumonia receive the most appropriate antimicrobial regimen based on patient-specific factors, severity of illness, recent antimicrobial exposure, and risk of drug-resistant pathogens.
American Journal of Respiratory and Critical Care Medicine
Macrolide-Resistant Pneumococcus in Community-acquired Pneumonia. Is There Still a Role for Macrolide Therapy?
Macrolide-Resistant Pneumococcus in Community-acquired Pneumonia. Is There Still a Role for Macrolide Therapy?
Streptococcus pneumoniae remains the most common cause of community-acquired pneumonia (CAP), and current guidelines recommend that empiric therapy of CAP always provide coverage for this organism and that therapy choices consider the risk factors for pneumococcal resistance ( 1 ).
What biomarkers are used in CAP?
Since CAP is a condition with intense inflammatory activity, several studies have evaluated various biomarkers (C-reactive protein, procalcitonin, proadrenomedullin, lactate, natriuretic atrial peptide, D-dimers, cortisol, etc.) in recent years, with C-reactive protein and procalcitonin being the most commonly studied.
Can chest X-rays be used for pneumonia?
At this level of care, when the clinician is sure of the diagnosis, chest X-ray is not required for treatment initiation, and antimicrobials can be prescribed appropriately. However, fewer than 40% of physicians are able to diagnose pneumonias solely on the basis of physical examination.
How long should you be under observation for chicken allergy?
People with a history of severe allergy to chicken eggs, with signs of anaphylaxis, should receive the vaccine in a setting in which anaphylactic reactions can be treated and should remain under observation for at least 30 minutes. In cases of fever, vaccination should be postponed until remission occurs.
What is the sensitivity of ultrasound?
When conducted by ultrasound specialists, ultrasound reaches a sensitivity of 94% and a specificity of 96%. However, the yield of ultrasound conducted by clinicians in the emergency department has yet to be further evaluated, and more robust evidence is needed.