Diagnosis and treatment of community-acquired pneumonia.

Patients with community-acquired pneumonia often present with cough, fever, chills, fatigue, dyspnea, rigors, and pleuritic chest pain. When a patient presents with suspected community-acquired pneumonia, the physician should first assess the need for hospitalization using a mortality prediction tool, such as the Pneumonia Severity Index, combined with clinical judgment. Consensus guidelines from several organizations recommend empiric therapy with macrolides, fluoroquinolones, or doxycycline. Patients who are hospitalized should be switched from parenteral antibiotics to oral antibiotics after their symptoms improve, they are afebrile, and they are able to tolerate oral medications. Clinical pathways are important tools to improve care and maximize cost-effectiveness in hospitalized patients.

[1]  The therapeutic monitoring of antimicrobial agents. , 2001, British journal of clinical pharmacology.

[2]  M. Bergeron,et al.  Sequential antibiotic therapy: Effective cost management and patient care. , 1995, The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses.

[3]  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.

[4]  M. Podgornik,et al.  2004 National Hospital Discharge Survey. , 2006, Advance data.

[5]  E. Arias,et al.  Deaths: final data for 2001. , 2003, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[6]  L. Mandell.  Community-acquired pneumonia. Etiology, epidemiology, and treatment. , 1995, Chest.

[7]  M. Fine,et al.  A prediction rule to identify low-risk patients with community-acquired pneumonia. , 1997, The New England journal of medicine.

[8]  E. Graves.  National Hospital Discharge Survey. , 1989, Vital and health statistics. Series 13, Data from the National Health Survey.

[9]  L. Mandell.  Antibiotic therapy for community-acquired pneumonia. , 1999, Clinics in chest medicine.

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

[11]  C. Goss,et al.  Cost and incidence of social comorbidities in low-risk patients with community-acquired pneumonia admitted to a public hospital. , 2003, Chest.

[12]  M E Brier,et al.  Early switch from intravenous to oral antibiotics and early hospital discharge: a prospective observational study of 200 consecutive patients with community-acquired pneumonia. , 1999, Archives of internal medicine.

[13]  John G. Bartlett,et al.  Update of Practice Guidelines for the Management of Community-Acquired Pneumonia in Immunocompetent Adults , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  J. Dorca,et al.  Etiology, reasons for hospitalization, risk classes, and outcomes of community-acquired pneumonia in patients hospitalized on the basis of conventional admission criteria. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  Intravenous‐to‐Oral Transition Therapy in Community‐Acquired Pneumonia: The INOVA Health System Experience , 2001, Pharmacotherapy.

[16]  A. Ellrodt,et al.  Identification of low-risk hospitalized patients with pneumonia. Implications for early conversion to oral antimicrobial therapy. , 1994, Chest.

[17]  Sheldon P Stone,et al.  Community-acquired pneumonia , 1998, The Lancet.

[18]  Carl S. Remmert,et al.  An Introduction to Critical Paths , 2005, Quality management in health care.

[19]  Lee Kang Hoe,et al.  Hospitalized low‐risk community‐acquired pneumonia: Outcome and potential for cost‐savings , 1999, Respirology.

[20]  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.

[21]  Ronald N. Jones,et al.  Influence of patient age on the susceptibility patterns of Streptococcus pneumoniae isolates in North America (2000-2001): report from the SENTRY Antimicrobial Surveillance Program. , 2003, Diagnostic microbiology and infectious disease.

[22]  N. Halpern,et al.  A prospective randomized study of inpatient iv. antibiotics for community-acquired pneumonia. The optimal duration of therapy. , 1996, Chest.

[23]  T. Marrie,et al.  The contribution of blood cultures to the clinical management of adult patients admitted to the hospital with community-acquired pneumonia: a prospective observational study. , 2003, Chest.

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

[25]  T. Avšič-Županc,et al.  Aetiology and Clinical Presentation of Mild Community-Acquired Bacterial Pneumonia , 2003, European Journal of Clinical Microbiology and Infectious Diseases.

[26]  J. Ramirez,et al.  Hospitalization for community-acquired pneumonia: the pneumonia severity index vs clinical judgment. , 2003, Chest.

[27]  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.

[28]  M. Fine,et al.  The hospital admission decision for patients with community-acquired pneumonia. Results from the pneumonia Patient Outcomes Research Team cohort study. , 1997, Archives of internal medicine.

[29]  J. Bartlett,et al.  Implications for macrolide treatment in community-acquired pneumonia. Hopkins CAP Team. , 1998, Chest.

[30]  M. Fine,et al.  Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia. , 2000, The American journal of medicine.

[31]  L. Mandell.  Antibiotics for pneumonia therapy. , 1994, The Medical clinics of North America.