Update of Practice Guidelines for the Management of Community-Acquired Pneumonia in Immunocompetent Adults

The Infectious Diseases Society of America (IDSA) produced guidelines for community-acquired pneumonia (CAP) in immunocompetent adults in 1998 and again in 2000 [1, 2]. Because of evolving resistance to antimicrobials and other advances, it was felt that an update should be provided every few years so that important developments could be highlighted and pressing questions answered. We addressed those issues that the committee believed were important to the practicing physician, including suggestions for initial empiric therapy for CAP. In some cases, only a few paragraphs were needed, whereas, in others, a somewhat more in-depth discussion was provided. Because many physicians focus on the tables rather than on the text of guidelines, it was decided that all of the information dealing with the initial empiric treatment regimens should be in tabular format with footnotes (tables 1–3). The topics selected for updating have been organized according to the headings used in the August 2000 CAP guidelines pub-

[1]  M. Kolczak,et al.  Incidence of Community-Acquired Pneumonia Requiring Hospitalization Results of a Population-Based Active Surveillance Study in Ohio , 1997 .

[2]  A. Torres,et al.  Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. , 1999, American journal of respiratory and critical care medicine.

[3]  M. Jacobs,et al.  Susceptibilities of Penicillin- and Erythromycin-Susceptible and -Resistant Pneumococci to HMR 3647 (RU 66647), a New Ketolide, Compared with Susceptibilities to 17 Other Agents , 1998, Antimicrobial Agents and Chemotherapy.

[4]  Schwartz Js,et al.  The Clinical Effectiveness of Pneumococcal Vaccine in the Elderly , 1988 .

[5]  P. Mäkelä,et al.  Risk factors for pneumonia in the elderly. , 1994, The American journal of medicine.

[6]  W. Craig,et al.  A comparison of cefditoren pivoxil and amoxicillin/ clavulanate in the treatment of community-acquired pneumonia: a multicenter, prospective, randomized, investigator-blinded, parallel-group study. , 2002, Clinical therapeutics.

[7]  Resistance of Streptococcus pneumoniae to fluoroquinolones--United States, 1995-1999. , 2001, MMWR. Morbidity and mortality weekly report.

[8]  Malbea A Lapete,et al.  Morbidity and Mortality Weekly Report Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (acip) Centers for Disease Control and Prevention Epidemiology Program Office Early Release 1 Prevention and Control of Influenza Recommendations of the Advis , 2022 .

[9]  N. Miyashita,et al.  In vitro activity of telithromycin, a new ketolide, against Chlamydia pneumoniae. , 2001, The Journal of antimicrobial chemotherapy.

[10]  W Schaffner,et al.  Tularemia: A 30‐Year Experience With 88 Cases , 1985, Medicine.

[11]  R. Holman,et al.  Discriminators between hantavirus-infected and -uninfected persons enrolled in a trial of intravenous ribavirin for presumptive hantavirus pulmonary syndrome. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  L. Hagberg,et al.  Telithromycin in the treatment of community-acquired pneumonia: a pooled analysis. , 2003, Respiratory medicine.

[13]  M. Kolczak,et al.  Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team. , 2000, The New England journal of medicine.

[14]  Louis T van Zyl,et al.  Cefditoren pivoxil versus cefpodoxime proxetil for community-acquired pneumonia: results of a multicenter, prospective, randomized, double-blind study. , 2002, Clinical therapeutics.

[15]  J. Lau,et al.  Meta-analysis of randomized controlled trials on the comparative efficacy and safety of azithromycin against other antibiotics for upper respiratory tract infections. , 2001, The Journal of antimicrobial chemotherapy.

[16]  P. Cuddy,et al.  Fluoroquinolone Treatment of Community-Acquired Pneumonia: A Meta-Analysis , 2002, The Annals of pharmacotherapy.

[17]  Karen McAulay,et al.  Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial , 2000, The Lancet.

[18]  Philip K. Russell,et al.  Tularemia as a biological weapon: medical and public health management. , 2001, JAMA.

[19]  D. Battleman,et al.  Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia: link between quality of care and resource utilization. , 2002, Archives of internal medicine.

[20]  L. Brammer,et al.  Influenza surveillance--United States, 1992-93 and 1993-94. , 1997, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[21]  M. Leinonen,et al.  role of serum troponin levels combined with electrocardiographic findings Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines , 2001 .

[22]  B. Marston,et al.  Surveillance for Legionnaires' disease. Risk factors for morbidity and mortality. , 1994, Archives of internal medicine.

[23]  Steven D. Brown,et al.  In vitro activity of telithromycin against Streptococcus pneumoniae resistant to other antibiotics, including cefotaxime. , 2002, The Journal of antimicrobial chemotherapy.

[24]  H. Sacks,et al.  The Efficacy of Influenza Vaccine in Elderly Persons , 1995, Annals of Internal Medicine.

[25]  T. Marrie,et al.  Antibiotic therapy for ambulatory patients with community-acquired pneumonia in an emergency department setting. , 2003, Archives of internal medicine.

[26]  D. Stott,et al.  Influenza Vaccination of Health Care Workers in Long-Term-Care Hospitals Reduces the Mortality of Elderly Patients , 1997, The Journal of infectious diseases.

[27]  P. Black.  Anti-inflammatory effects of macrolide antibiotics. , 1997, The European respiratory journal.

[28]  J. Hughes,et al.  Antimicrobial-Drug Prescription in Ambulatory Care Settings, United States, 1992–2000 , 2003, Emerging infectious diseases.

[29]  P. Kaufman.  PNEUMONIA IN OLD AGE: Active Immunization Against Pneumonia with Pneumococcus Polysaccharide; Results of a Six Year Study , 1947 .

[30]  M. Jacobs,et al.  Activity of cefditoren against respiratory pathogens. , 2002, The Journal of antimicrobial chemotherapy.

[31]  S. Twu,et al.  Update: outbreak of severe acute respiratory syndrome--worldwide, 2003. , 2003, MMWR. Morbidity and mortality weekly report.

[32]  L. Kaiser,et al.  Hospitalizing influenza in adults. , 1999, Current clinical topics in infectious diseases.

[33]  F. Hayden,et al.  Selection of influenza virus mutants in experimentally infected volunteers treated with oseltamivir. , 2001, The Journal of infectious diseases.

[34]  J. Gerberding,et al.  Update: Outbreak of severe acute respiratory syndrome--worldwide, 2003. , 2003, MMWR. Morbidity and mortality weekly report.

[35]  M. Ferraro.  The Rise of Fluoroquinolone Resistance: Fact or Fiction , 2002, Journal of chemotherapy.

[36]  P. Ward,et al.  Use of the oral neuraminidase inhibitor oseltamivir in experimental human influenza: randomized controlled trials for prevention and treatment. , 1999, JAMA.

[37]  T. Marrie,et al.  A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. , 2000, JAMA.

[38]  L. Mandell,et al.  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. The Canadian Community-Acquired Pneumonia Working Group. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[39]  D. Low,et al.  A nosocomial outbreak of fluoroquinolone-resistant Streptococcus pneumoniae. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[40]  A. Schuchat,et al.  The emergence of Streptococcus pneumoniae resistant to macrolide antimicrobial agents: a 6-year population-based assessment. , 2000, The Journal of infectious diseases.

[41]  G. Doern,et al.  Antimicrobial Resistance with Streptococcus Pneumoniae in the United States , 2000, Seminars in respiratory and critical care medicine.

[42]  L. Danziger,et al.  Intrapulmonary steady-state concentrations of clarithromycin and azithromycin in healthy adult volunteers , 1997, Antimicrobial agents and chemotherapy.

[43]  R. Breiman,et al.  Prevention of pneumococcal disease : recommendations of the Advisory Committee on Immunization Practices (ACIP) , 1997 .

[44]  G. Doern,et al.  Worldwide prevalence of antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the SENTRY Antimicrobial Surveillance Program, 1997-1999. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[45]  T. File,et al.  Efficacy and safety of gemifloxacin in the treatment of community-acquired pneumonia: a randomized, double-blind comparison with trovafloxacin. , 2001, The Journal of antimicrobial chemotherapy.

[46]  P. Ward,et al.  Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial. US Oral Neuraminidase Study Group. , 2000, JAMA.

[47]  G. Wewalka,et al.  Clinical Utility of Urinary Antigen Detection for Diagnosis of Community-Acquired, Travel-Associated, and Nosocomial Legionnaires' Disease , 2003, Journal of Clinical Microbiology.

[48]  James R. Johnson.  Doxycycline for treatment of community-acquired pneumonia. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[49]  F. Baquero,et al.  Antimicrobial Susceptibilities of 1,684 Streptococcus pneumoniae and 2,039 Streptococcus pyogenesIsolates and Their Ecological Relationships: Results of a 1-Year (1998–1999) Multicenter Surveillance Study in Spain , 2001, Antimicrobial Agents and Chemotherapy.

[50]  K G Moons,et al.  Clinical signs and symptoms predicting influenza infection. , 2001, Archives of internal medicine.

[51]  G. Royo,et al.  Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[52]  G. Woods,et al.  A study evaluating the efficacy, safety, and tolerability of ertapenem versus ceftriaxone for the treatment of community-acquired pneumonia in adults. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[53]  M. Leinonen,et al.  Microbial etiology of community-acquired pneumonia in the adult population of 4 municipalities in eastern Finland. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[54]  D E Low,et al.  Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. Canadian Bacterial Surveillance Network. , 1999, The New England journal of medicine.

[55]  A. Cross,et al.  Efficacy of pneumococcal vaccine in high-risk patients. Results of a Veterans Administration Cooperative Study. , 1986, The New England journal of medicine.

[56]  V. Yu,et al.  New Directions for Future Studies of Community-Acquired Pneumonia: Optimizing Impact on Patient Care , 1999, European Journal of Clinical Microbiology and Infectious Diseases.

[57]  Facilitating influenza and pneumococcal vaccination through standing orders programs. , 2003, MMWR. Morbidity and mortality weekly report.

[58]  W. Kapoor,et al.  New and Emerging Etiologies for Community‐Acquired Pneumonia with Implications for Therapy: A Prospective Multicenter Study of 359 Cases , 1990, Medicine.

[59]  Ken-Ichiro Inoue,et al.  Fatal Pneumococcal Pneumonia Attributed to Macrolide Resistance and Azithromycin Monotherapy , 2000 .

[60]  E. Walsh,et al.  Human metapneumovirus infections in young and elderly adults. , 2003, The Journal of infectious diseases.

[61]  S. Walter,et al.  Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. , 1999, Archives of internal medicine.

[62]  D. Schwartz,et al.  Exposure of Laboratory Workers to Francisella tularensis despite a Bioterrorism Procedure , 2002, Journal of Clinical Microbiology.

[63]  M. Loeb,et al.  Clinical and epidemiologic features of group a streptococcal pneumonia in Ontario, Canada. , 2003, Archives of internal medicine.

[64]  L. Hagberg,et al.  Efficacy and Tolerability of Once-Daily Telithromycin Compared with High-Dose Amoxicillin for Treatment of Community-Acquired Pneumonia , 2002, Infection.

[65]  J. Dixon.  PNEUMOCOCCUS RESISTANT TO ERYTHROMYCIN AND LINCOMYCIN , 1967 .

[66]  C. Bridges,et al.  Using live, attenuated influenza vaccine for prevention and control of influenza: supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP). , 2003, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[67]  W. Scheld,et al.  Maintaining Fluoroquinolone Class Efficacy: Review of Influencing Factors , 2003, Emerging infectious diseases.

[68]  M. Fisch,et al.  Preventing pneumococcal bacteremia in patients at risk. Results of a matched case-control study. , 1995, Archives of internal medicine.

[69]  Jerome Hauer,et al.  Anthrax as a biological weapon, 2002: updated recommendations for management. , 2002, JAMA.

[70]  Xilin Zhao,et al.  Resistance to levofloxacin and failure of treatment of pneumococcal pneumonia. , 2002, The New England journal of medicine.

[71]  A. Rosenstein,et al.  Timing Is Everything: Impact of Emergency Department Care on Hospital Length of Stay , 2000 .

[72]  D. Low,et al.  Is resistance futile? , 2003, Nature Medicine.

[73]  T. File,et al.  Efficacy and safety of gemifloxacin 320 mg once-daily for 7 days in the treatment of adult lower respiratory tract infections. , 2001, International journal of antimicrobial agents.

[74]  P. Nikolaides,et al.  Randomized Controlled Trial of Sequential Intravenous (i.v.) and Oral Moxifloxacin Compared with Sequential i.v. and Oral Co-Amoxiclav with or without Clarithromycin in Patients with Community-Acquired Pneumonia Requiring Initial Parenteral Treatment , 2002, Antimicrobial Agents and Chemotherapy.

[75]  P. Courvalin,et al.  Two New Mechanisms of Macrolide Resistance in Clinical Strains ofStreptococcus pneumoniae from Eastern Europe and North America , 2000, Antimicrobial Agents and Chemotherapy.

[76]  Keiji Fukuda,et al.  Mortality associated with influenza and respiratory syncytial virus in the United States. , 2003, JAMA.

[77]  Ronald N. Jones,et al.  Worldwide Antimicrobial Susceptibility Patterns and Pharmacodynamic Comparisons of Gatifloxacin and Levofloxacin against Streptococcus pneumoniae: Report from the Antimicrobial Resistance Rate Epidemiology Study Team , 2003, Antimicrobial Agents and Chemotherapy.

[78]  P. Reiss,et al.  Failure of macrolide antibiotic treatment in patients with bacteremia due to erythromycin-resistant Streptococcus pneumoniae. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[79]  A. Evangelista,et al.  Regional trends in antimicrobial resistance among clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the United States: results from the TRUST Surveillance Program, 1999-2000. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[80]  S. Cammarata,et al.  Linezolid Versus Ceftriaxone/Cefpodoxime in Patients Hospitalized for the Treatment of Streptococcus pneumoniae Pneumonia , 2002, Scandinavian journal of infectious diseases.

[81]  I. Friedland.  Comparison of the response to antimicrobial therapy of penicillin‐resistant and penicillin‐susceptible pneumococcal disease , 1995, The Pediatric infectious disease journal.

[82]  Susan R. Johnson,et al.  Macrolide Resistance among Invasive Streptococcus Pneumoniae Isolates , 2022 .

[83]  S. Osajima.  [VIRAL PNEUMONIA]. , 1963, Naika. Internal medicine.

[84]  S. Kohno,et al.  Community-acquired respiratory tract infections caused by resistant pneumococci: clinical and bacteriological efficacy of the ketolide telithromycin. , 2003, The Journal of antimicrobial chemotherapy.

[85]  G. Sarosi,et al.  Azithromycin vs cefuroxime plus erythromycin for empirical treatment of community-acquired pneumonia in hospitalized patients: a prospective, randomized, multicenter trial. , 2000, Archives of internal medicine.

[86]  R. Carlucci,et al.  Evaluation of a rapid test (QuickVue) compared with the shell vial assay for detection of influenza virus clearance after antiviral treatment. , 2003, Journal of virological methods.

[87]  P. Geslin,et al.  Once-daily sparfloxacin versus high-dosage amoxicillin in the treatment of community-acquired, suspected pneumococcal pneumonia in adults. Sparfloxacin European Study Group. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[88]  E. Choi,et al.  Clinical outcome of invasive infections by penicillin-resistant Streptococcus pneumoniae in Korean children. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[89]  J. Wu,et al.  Telithromycin- and Fluoroquinolone-Resistant Streptococcus pneumoniae in Taiwan with High Prevalence of Resistance to Macrolides and β-Lactams: SMART Program 2001 Data , 2003, Antimicrobial Agents and Chemotherapy.

[90]  G. Doern,et al.  Prevalence of macrolide resistance mechanisms in Streptococcus pneumoniae isolates from a multicenter antibiotic resistance surveillance study conducted in the United States in 1994-1995. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[91]  G. Sarosi,et al.  Evaluation of the Winthrop-University Hospital criteria to identify Legionella pneumonia. , 2001, Chest.

[92]  B. Rasoamanana,et al.  [Sensitivity of Yersinia pestis to antibiotics: 277 strains isolated in Madagascar between 1926 and 1989]. , 1989, Archives de l'Institut Pasteur de Madagascar.

[93]  P. Edelstein.  Antimicrobial Chemotherapy for Legionnaires Disease: Time for a Change , 1998, Annals of Internal Medicine.

[94]  J. Bartlett,et al.  GUIDELINES FROM THE INFECTIOUS DISEASES SOCIETY OF AMERICA Community-Acquired Pneumonia in Adults: Guidelines for Management , 1998 .

[95]  B. Weisblum.  Pneumococcus resistant to erythromycin and lincomycin. , 1967, Lancet.

[96]  B. Plikaytis,et al.  Antimicrobial resistance of Streptococcus pneumoniae in the United States, 1979-1987. The Pneumococcal Surveillance Working Group. , 1991, The Journal of infectious diseases.

[97]  D Draper,et al.  Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. , 1990, JAMA.

[98]  D. Fleming,et al.  Cluster of severe acute respiratory syndrome cases among protected health-care workers--Toronto, Canada, April 2003. , 2003, MMWR. Morbidity and mortality weekly report.

[99]  Malik Peiris,et al.  Aetiology: Koch's postulates fulfilled for SARS virus , 2003, Nature.

[100]  J. A. Comer,et al.  A novel coronavirus associated with severe acute respiratory syndrome. , 2003, The New England journal of medicine.

[101]  Fatal human plague--Arizona and Colorado, 1996. , 1997, Canada communicable disease report = Releve des maladies transmissibles au Canada.

[102]  B. Greenwood,et al.  Evaluation of Binax now Streptococcus pneumoniae urinary antigen test in children in a community with a high carriage rate of pneumococcus. , 2001, The Pediatric infectious disease journal.

[103]  Michael J Fine,et al.  Testing Strategies in the Initial Management of Patients with Community-Acquired Pneumonia , 2002, Annals of Internal Medicine.

[104]  P. Edelstein,et al.  In Vitro Activity of the Ketolide HMR 3647 (RU 6647) for Legionella spp., Its Pharmacokinetics in Guinea Pigs, and Use of the Drug To Treat Guinea Pigs withLegionella pneumophila Pneumonia , 1999, Antimicrobial Agents and Chemotherapy.

[105]  C. Muller-Serieys,et al.  Intrapulmonary Pharmacokinetics of Telithromycin, a New Ketolide, in Healthy Japanese Volunteers , 2002, Antimicrobial Agents and Chemotherapy.

[106]  B. Bozdoğan,et al.  Incidence, Epidemiology, and Characteristics of Quinolone- Nonsusceptible Streptococcus pneumoniae in Croatia , 2002, Antimicrobial Agents and Chemotherapy.

[107]  C. Cabellos,et al.  Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain. , 1995, The New England journal of medicine.

[108]  R. Leclercq,et al.  Resistance to Macrolides and Related Antibiotics in Streptococcus pneumoniae , 2002, Antimicrobial Agents and Chemotherapy.

[109]  A. Schuchat,et al.  Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. , 2000, American journal of public health.

[110]  R. Wunderink,et al.  Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. , 2001, Archives of internal medicine.

[111]  M. Fine,et al.  Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. , 2002, Archives of internal medicine.

[112]  A. Torres,et al.  Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae. , 1999, American journal of respiratory and critical care medicine.

[113]  G. Doern.  Antimicrobial use and the emergence of antimicrobial resistance with Streptococcus pneumoniae in the United States. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[114]  W. Olson,et al.  A multicenter, open-label, randomized comparison of levofloxacin and azithromycin plus ceftriaxone in hospitalized adults with moderate to severe community-acquired pneumonia. , 2002, Clinical therapeutics.

[115]  C. P. Quinn,et al.  Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States. , 2001, Emerging infectious diseases.

[116]  Christian Drosten,et al.  Identification of a novel coronavirus in patients with severe acute respiratory syndrome. , 2003, The New England journal of medicine.

[117]  P. Rhomberg,et al.  Fluoroquinolone Resistance in Streptococcus pneumoniae in United States since 1994-1995 , 2002, Antimicrobial Agents and Chemotherapy.

[118]  D. Snydman,et al.  An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[119]  R. Adair,et al.  The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. , 1991, The New England journal of medicine.

[120]  D. Yealy.  Translating the Pneumonia Severity Index into Practice: A Trial to Influence the Admission Decision , 2002 .

[121]  Anil T Ahuja,et al.  Severe acute respiratory syndrome: radiographic appearances and pattern of progression in 138 patients. , 2003, Radiology.

[122]  J. Kolman,et al.  Susceptibilities to Telithromycin and Six Other Agents and Prevalence of Macrolide Resistance Due to L4 Ribosomal Protein Mutation among 992 Pneumococci from 10 Central and Eastern European Countries , 2002, Antimicrobial Agents and Chemotherapy.

[123]  L. Mandell,et al.  Oral gemifloxacin versus sequential therapy with intravenous ceftriaxone/oral cefuroxime with or without a macrolide in the treatment of patients hospitalized with community-acquired pneumonia: a randomized, open-label, multicenter study of clinical efficacy and tolerability. , 2002, Clinical therapeutics.

[124]  J. Bartlett,et al.  Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. , 2004, Archives of internal medicine.

[125]  D. Murdoch,et al.  Diagnosis of Legionella Infection , 2002 .

[126]  C. Prat,et al.  Detection of Streptococcus pneumoniae antigen by a rapid immunochromatographic assay in urine samples. , 2001, Chest.

[127]  F. Hayden,et al.  Impact of zanamivir on antibiotic use for respiratory events following acute influenza in adolescents and adults. , 2000, Archives of internal medicine.

[128]  J. Bosso,et al.  Comparative activity of gatifloxacin and other antibiotics against 4009 clinical isolates of Streptococcus pneumoniae in the United States during 1999-2000. , 2002, Diagnostic microbiology and infectious disease.

[129]  J. Dorca,et al.  Usefulness of betalactam therapy for community-acquired pneumonia in the era of drug-resistant Streptococcus pneumoniae: a randomized study of amoxicillin-clavulanate and ceftriaxone. , 2001, Microbial drug resistance.

[130]  M. Leinonen,et al.  Randomised trial of 23-valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people , 1998, The Lancet.

[131]  Philip K. Russell,et al.  Smallpox as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. , 1999, JAMA.

[132]  K. Klugman.  The role of clonality in the global spread of fluoroquinolone-resistant bacteria. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[133]  C. Whitney,et al.  Cost-Effectiveness of Vaccination against Invasive Pneumococcal Disease among People 50 through 64 Years of Age: Role of Comorbid Conditions and Race , 2003, Annals of Internal Medicine.

[134]  A. Tomasz,et al.  Molecular characterization of penicillin-resistant Streptococcus pneumoniae isolates causing respiratory disease in the United States. , 1998, Microbial drug resistance.

[135]  C. Whitney,et al.  Invasive Pneumococcal Disease in Older Adults Residing in Long‐Term Care Facilities and in the Community , 2003, Journal of the American Geriatrics Society.

[136]  P. Rhomberg,et al.  Antimicrobial Resistance among Clinical Isolates ofStreptococcus pneumoniae in the United States during 1999–2000, Including a Comparison of Resistance Rates since 1994–1995 , 2001, Antimicrobial Agents and Chemotherapy.

[137]  S. Dowell,et al.  Evaluation of Binax NOW, an assay for the detection of pneumococcal antigen in urine samples, performed among pediatric patients. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[138]  R. Titball,et al.  Efficacy of doxycycline and ciprofloxacin against experimental Yersinia pestis infection. , 1998, The Journal of antimicrobial chemotherapy.

[139]  D. Landman,et al.  Streptococcus pneumoniae, Brooklyn, New York: Fluoroquinolone Resistance at our Doorstep , 2002, Emerging infectious diseases.

[140]  M. Pfaller,et al.  Use of Penicillin MICs To Predict In Vitro Activity of Other β-Lactam Antimicrobial Agents againstStreptococcus pneumoniae , 2001, Journal of Clinical Microbiology.

[141]  D. Murdoch,et al.  Evaluation of a Rapid Immunochromatographic Test for Detection of Streptococcus pneumoniae Antigen in Urine Samples from Adults with Community-Acquired Pneumonia , 2001, Journal of Clinical Microbiology.

[142]  J. Dorca,et al.  Efficacy and Safety of Sequential Amoxicillin-Clavulanate in the Treatment of Anaerobic Lung Infections , 2003, European Journal of Clinical Microbiology and Infectious Diseases.

[143]  H. Faden,et al.  Urinary excretion of pneumococcal cell wall polysaccharide in children. , 2002, The Pediatric infectious disease journal.

[144]  M. Kolczak,et al.  Cigarette smoking and invasive pneumococcal disease , 2000 .

[145]  D. Xuan,et al.  Pharmacodynamic Assessment of Clarithromycin in a Murine Model of Pneumococcal Pneumonia , 2002, Antimicrobial Agents and Chemotherapy.

[146]  T. Quinn,et al.  Oral gatifloxacin in outpatient community-acquired pneumonia: results from TeqCES, a community-based, open-label, multicenter study. , 2002, Diagnostic microbiology and infectious disease.

[147]  V. Cheng,et al.  Risk factors for acquisition of levofloxacin-resistant Streptococcus pneumoniae: a case-control study. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[148]  T. Busman,et al.  A controlled, double-blind, multicenter study comparing clarithromycin extended-release tablets and levofloxacin tablets in the treatment of community-acquired pneumonia. , 2002, Clinical therapeutics.

[149]  R. Leclercq.  Will resistance to ketolides develop in Streptococcus pneumoniae? , 2002, The Journal of infection.

[150]  M. Delaforge,et al.  Conformational analysis of ketolide, conformations of RU 004 in solution and bound to bacterial ribosomes. , 1998, Journal of medicinal chemistry.

[151]  John Mullooly,et al.  Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. , 2003, The New England journal of medicine.

[152]  D. Sahm,et al.  Analysis of Ciprofloxacin Activity against Streptococcus pneumoniae after 10 Years of Use in the United States , 2000, Antimicrobial Agents and Chemotherapy.

[153]  Norbert Vetter,et al.  A prospective, randomized, double-blind multicenter comparison of parenteral ertapenem and ceftriaxone for the treatment of hospitalized adults with community-acquired pneumonia. , 2002, Clinical therapeutics.

[154]  Pneumonia and influenza death rates--United States, 1979-1994. , 1995, MMWR. Morbidity and mortality weekly report.

[155]  D. Fleming,et al.  Human Metapneumovirus as a Cause of Community-Acquired Respiratory Illness , 2002, Emerging infectious diseases.

[156]  D. Looke,et al.  Delay in appropriate therapy ofLegionella pneumonia associated with increased mortality , 1996, European Journal of Clinical Microbiology and Infectious Diseases.

[157]  J. Schellekens,et al.  UvA-DARE ( Digital Academic Repository ) A large outbreak of Legionnaires ' disease at a flower show , the Netherlands , 1999 , 2001 .

[158]  Michael J Fine,et al.  Practice Guidelines for the Management of Community-Acquired Pneumonia in Adults , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[159]  John J. Treanor,et al.  Efficacy and Safety of the Oral Neuraminidase Inhibitor Oseltamivir in Treating Acute Influenza , 2000 .

[160]  P. Marik,et al.  Influenza pneumonia: a descriptive study. , 2001, Chest.

[161]  The urinary antigen test for the diagnosis of pneumococcal pneumonia. , 2001, Chest.

[162]  W. Peetermans,et al.  Breakthrough pneumococcal bacteraemia in patients treated with clarithromycin or oral beta-lactams. , 2003, The Journal of antimicrobial chemotherapy.

[163]  Philip K. Russell,et al.  Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. , 2000, JAMA.

[164]  M. Fine,et al.  Quality of care, process, and outcomes in elderly patients with pneumonia. , 1997, JAMA.

[165]  J. Schwartz,et al.  The clinical effectiveness of pneumococcal vaccine in the elderly. , 1988, Annals of internal medicine.

[166]  Outbreak of severe acute respiratory syndrome--worldwide, 2003. , 2003, MMWR. Morbidity and mortality weekly report.

[167]  韩旭东,et al.  Viral pneumonia , 2004 .

[168]  J. Sobel,et al.  Invasive candidiasis: turning risk into a practical prevention policy? , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[169]  E. Perea,et al.  Uptake and intracellular activity of ketolide HMR 3647 in human phagocytic and non-phagocytic cells. , 2001, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[170]  Onchee Yu,et al.  Effectiveness of pneumococcal polysaccharide vaccine in older adults. , 2003, The New England journal of medicine.

[171]  Updated interim surveillance case definition for severe acute respiratory syndrome (SARS)--United States, April 29, 2003. , 2003, MMWR. Morbidity and mortality weekly report.

[172]  A. Goglio,et al.  Urinary detection of Streptococcus pneumoniae antigen for diagnosis of pneumonia. , 2002, The new microbiologica.

[173]  Laurent Kaiser,et al.  Influenza virus neuraminidase inhibitors , 2000, The Lancet.

[174]  J. Schellekens,et al.  A Large Outbreak of Legionnaires’ Disease at a Flower Show, the Netherlands, 1999 , 2002, Emerging infectious diseases.

[175]  P. Gilligan,et al.  Breakthrough pneumococcal bacteremia in patients being treated with azithromycin and clarithromycin. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[176]  Marc Lipsitch,et al.  Geographic diversity and temporal trends of antimicrobial resistance in Streptococcus pneumoniae in the United States , 2003, Nature Medicine.

[177]  R. Holman,et al.  Intravenous Ribavirin for Hantavirus Pulmonary Syndrome: Safety and Tolerance during 1 Year of Open-Label Experience , 1998, Antiviral therapy.

[178]  A. Benin,et al.  An outbreak of travel-associated Legionnaires disease and Pontiac fever: the need for enhanced surveillance of travel-associated legionellosis in the United States. , 2002, The Journal of infectious diseases.

[179]  Case definitions for infectious conditions under public health surveillance. Centers for Disease Control and Prevention. , 1997, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[180]  D. Musher,et al.  Emergence of macrolide resistance during treatment of pneumococcal pneumonia. , 2002, The New England journal of medicine.

[181]  M. Mallaret,et al.  [Clinical trial of an antipneumococcal vaccine in elderly subjects living in institutions]. , 1985, Revue d'epidemiologie et de sante publique.

[182]  F. Martinez,et al.  Clinical relevance of macrolide-resistant Streptococcus pneumoniae for community-acquired pneumonia. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[183]  R. Muder.  Pneumonia in residents of long-term care facilities: epidemiology, etiology, management, and prevention. , 1998, The American journal of medicine.

[184]  R. Couch,et al.  Impact of respiratory virus infections on persons with chronic underlying conditions. , 2000, JAMA.

[185]  D A Henderson,et al.  The looming threat of bioterrorism. , 1999, Science.

[186]  R. McGarvey,et al.  Pneumonia mortality reduction and quality improvement in a community hospital. , 1993, QRB. Quality review bulletin.

[187]  J. Amouroux,et al.  Assessment of a fluoroquinolone, three beta-lactams, two aminoglycosides, and a cycline in treatment of murine Yersinia pestis infection , 1994, Antimicrobial Agents and Chemotherapy.

[188]  J. Ruiz,et al.  Comparative study of Legionella pneumophila and other nosocomial-acquired pneumonias. , 1991, Chest.

[189]  J. Bartlett,et al.  A fresh look at the definition of susceptibility of Streptococcus pneumoniae to beta-lactam antibiotics. , 2001, Archives of internal medicine.

[190]  L. Mandell,et al.  What is optimal antimicrobial therapy for bacteremic pneumococcal pneumonia? , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[191]  J. P. Davis,et al.  Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). , 1997, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[192]  J. Justman,et al.  Penicillin resistance and other predictors of mortality in pneumococcal bacteremia in a population with high human immunodeficiency virus seroprevalence. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[193]  Fatal human plague--Arizona and Colorado, 1996. , 1997, MMWR. Morbidity and mortality weekly report.

[194]  K. Bush,et al.  Bacteremic pneumonia due to multidrug-resistant pneumococci in 3 patients treated unsuccessfully with azithromycin and successfully with levofloxacin. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[195]  M. Leinonen,et al.  Clinical efficacy of pneumococcal vaccine in the elderly: a randomized, single-blind population-based trial. , 1997, The American journal of medicine.

[196]  M. Hammerschlag,et al.  Efficacy and safety of gemifloxacin in the treatment of community-acquired pneumonia: a randomized, double-blind comparison with trovafloxacin. , 2001, The Journal of antimicrobial chemotherapy.

[197]  A. E. Physicians.  Clinical policy for the management and risk stratification of community-acquired pneumonia in adults in the emergency department. , 2001, Annals of emergency medicine.

[198]  L. H. Hansen,et al.  The macrolide–ketolide antibiotic binding site is formed by structures in domains II and V of 23S ribosomal RNA , 1999, Molecular microbiology.

[199]  D. Haake,et al.  Early treatment with acyclovir for varicella pneumonia in otherwise healthy adults: retrospective controlled study and review. , 1990, Reviews of infectious diseases.

[200]  A. Schuchat,et al.  Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group. , 2000, Archives of internal medicine.

[201]  J. Marimón,et al.  Spain14-5 international multiresistant Streptococcus pneumoniae clone resistant to fluoroquinolones and other families of antibiotics. , 2003, The Journal of antimicrobial chemotherapy.

[202]  J. Morera,et al.  Comparative study of the clinical presentation of Legionella pneumonia and other community-acquired pneumonias. , 1998, Chest.

[203]  Julie A. Pavlin,et al.  Medical Management of Biological Casualties Handbook [Third Edition] , 1998 .

[204]  M. Fine,et al.  Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. , 2001, American journal of respiratory and critical care medicine.

[205]  R. Roldán,et al.  Progression of chronic hepatitis C to liver fibrosis and cirrhosis in patients coinfected with hepatitis C virus and human immunodeficiency virus. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[206]  J. Pullman,et al.  EFFICACY AND TOLERABILITY OF ONCE‐DAILY ORAL THERAPY WITH TELITHROMYCIN COMPARED WITH TROVAFLOXACIN FOR THE TREATMENT OF COMMUNITY‐ACQUIRED PNEUMONIA IN ADULTS , 2003, International journal of clinical practice.

[207]  T. Ng,et al.  Increasing resistance of Streptococcus pneumoniae to fluoroquinolones: results of a Hong Kong multicentre study in 2000. , 2001, The Journal of antimicrobial chemotherapy.

[208]  J. Bartlett,et al.  Community‐Acquired Pneumonia: Impact of Immune Status , 1996, American journal of respiratory and critical care medicine.

[209]  R. Jacobs,et al.  Streptomycin and alternative agents for the treatment of tularemia: review of the literature. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[210]  R. Wunderink,et al.  Fatal pneumococcal pneumonia attributed to macrolide resistance and azithromycin monotherapy. , 2000, Chest.

[211]  L. Poon,et al.  Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia : a prospective study , 2003 .

[212]  Arthur S Slutsky,et al.  Identification of severe acute respiratory syndrome in Canada. , 2003, The New England journal of medicine.

[213]  K. Bowker,et al.  In-vitro activity of HMR 3647 against Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and beta-haemolytic streptococci. , 1999, The Journal of antimicrobial chemotherapy.

[214]  Thomas V Inglesby,et al.  Management of anthrax. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[215]  J. Karlowsky,et al.  Need for Annual Surveillance of Antimicrobial Resistance in Streptococcus pneumoniae in the United States: 2-Year Longitudinal Analysis , 2001, Antimicrobial Agents and Chemotherapy.

[216]  M. Fine,et al.  Associations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with pneumonia. , 1999, Archives of internal medicine.

[217]  J. Bates,et al.  Treatment of tularemia, including pulmonary tularemia, with gentamicin. , 1980, The American review of respiratory disease.

[218]  F. Hayden,et al.  Performance of virus isolation and Directigen Flu A to detect influenza A virus in experimental human infection. , 1999, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[219]  Á. Soriano,et al.  Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[220]  R. Breiman,et al.  Pneumococcal polysaccharide vaccine efficacy. An evaluation of current recommendations. , 1993, JAMA.

[221]  D. Fleming,et al.  Tularemia--United States, 1990-2000. , 2002, MMWR. Morbidity and mortality weekly report.

[222]  R. Peeling,et al.  Standardizing Chlamydia pneumoniae assays: recommendations from the Centers for Disease Control and Prevention (USA) and the Laboratory Centre for Disease Control (Canada). , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[223]  T. File,et al.  A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia , 1997, Antimicrobial agents and chemotherapy.

[224]  D. Musher,et al.  Nonspecificity of assaying for IgG antibody to pneumolysin in circulating immune complexes as a means to diagnose pneumococcal pneumonia. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[225]  D. Church,et al.  Antimicrobial Resistance among Clinical Isolates of Streptococcus pneumoniae in Canada during 2000 , 2002, Antimicrobial Agents and Chemotherapy.

[226]  M. Mufson,et al.  Bacteremic pneumococcal pneumonia in one American City: a 20-year longitudinal study, 1978-1997. , 1999, The American journal of medicine.

[227]  R. S. Levy,et al.  Clindamycin compared with penicillin for the treatment of anaerobic lung abscess. , 1983, Annals of internal medicine.

[228]  Dori B. Reissman,et al.  Clinical features that discriminate inhalational anthrax from other acute respiratory illnesses. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[229]  M. Chan-yeung,et al.  A cluster of cases of severe acute respiratory syndrome in Hong Kong. , 2003, The New England journal of medicine.

[230]  B. Feagan.  A Controlled Trial of a Critical Pathway for Treating Community‐Acquired Pneumonia: The CAPITAL Study , 2001, Pharmacotherapy.

[231]  A. Limaye,et al.  Treatment of tularemia with fluoroquinolones: two cases and review. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[232]  Christian Drosten,et al.  Characterization of a Novel Coronavirus Associated with Severe Acute Respiratory Syndrome , 2003, Science.

[233]  J. Dorca,et al.  Clindamycin vs penicillin for anaerobic lung infections. High rate of penicillin failures associated with penicillin-resistant Bacteroides melaninogenicus. , 1990, Archives of internal medicine.

[234]  M. Fine,et al.  Influence of age on symptoms at presentation in patients with community-acquired pneumonia. , 1997, Archives of internal medicine.

[235]  J. Rello,et al.  Legionnaires' disease: a rational approach to therapy. , 2003, The Journal of antimicrobial chemotherapy.

[236]  A. Schuchat,et al.  Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. , 2003, The New England journal of medicine.

[237]  J E Stahl,et al.  Effect of macrolides as part of initial empiric therapy on length of stay in patients hospitalized with community-acquired pneumonia. , 1999, Archives of internal medicine.