The science of selecting antimicrobials for community-acquired pneumonia (CAP).
Humans; Microbial Sensitivity Tests; Anti-Bacterial Agents/*therapeutic use; Practice Guidelines as Topic; Streptococcus pneumoniae/isolation & purification; Community-Acquired Infections/drug therapy; *Drug Resistance; beta-Lactams/*therapeutic use; Chlamydophila pneumoniae/isolation & purification; Fluoroquinolones/*therapeutic use; Legionnaires' Disease/drug therapy; Macrolides/*therapeutic use; Pneumonia; Bacterial; Drug Therapy; Bacterial/*drug therapy; Combination
BACKGROUND: Among infectious diseases, community-acquired pneumonia (CAP) is the leading cause of death in the United States and is associated with a substantial economic burden to the health care system. Initiating appropriate empiric therapy can be challenging given elevated resistance rates among Streptococcus pneumoniae strains. OBJECTIVE: To present current recommendations for management of CAP with respect to (a) choosing the appropriate site of care, and (b) antimicrobial selection based on bacterial etiology and the prevalence of resistance. SUMMARY: Mortality prediction tools, such as the PORT (Pneumonia Outcomes Research Team) Severity Index, CURB-65 (Confusion, Urea concentration, Respiratory rate, Blood pressure, and age\textgreater65), or CRB-65 (Confusion, Respiratory rate, Blood pressure, and age\textgreater65), can be invaluable in determining which CAP patients require hospitalization. These tools can help reduce overall costs for CAP by limiting hospitalizations of low-risk patients. S. pneumoniae remains the most common causative pathogen for CAP across all disease severities, and elevated rates of resistance to penicillin and macrolides can hinder selection of appropriate antimicrobial therapy. Antimicrobial resistance can impact clinical outcomes, including increasing the risk of treatment failure and breakthrough bacteremia. Current management guidelines recommend monotherapy with a respiratory fluoroquinolone or combination therapy with a beta-lactam and a macrolide (for patients admitted to the general medical ward) or with a beta-lactam and either a respiratory fluoroquinolone or a macrolide (for patients admitted to the intensive care unit [ICU] and who do not have risk factors for methicillin-resistant S. aureus or Pseudomonas). Optimized dosing regimens aim to ensure that pharmacokinetic and pharmacodynamic targets are met to achieve successful clinical outcomes and minimize resistance development. CONCLUSION: Effective management of patients with CAP requires selection of the proper site of care and appropriate empiric antimicrobial. Given the elevated rates of resistance among S. pneumoniae, local resistance patterns must be considered when choosing empiric therapy.
File Thomas M
Journal of managed care pharmacy : JMCP
2009
2009-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.18553/jmcp.2009.15.s2.5" target="_blank" rel="noreferrer noopener">10.18553/jmcp.2009.15.s2.5</a>
Clinical implications and treatment of multiresistant Streptococcus pneumoniae pneumonia.
Anti-Infective Agents/*therapeutic use; Bacterial; Community-Acquired Infections/*drug therapy/economics/*microbiology; Drug Resistance; Fluoroquinolones/*therapeutic use; Humans; Ketolides/therapeutic use; Multiple; Pneumococcal/*drug therapy/economics/*microbiology; Pneumonia; Streptococcus pneumoniae/*growth & development
Streptococcus pneumoniae is the leading bacterial cause of community-acquired respiratory tract infections. Prior to the 1970s this pathogen was uniformly susceptible to penicillin and most other antimicrobials. However, since the 1990s there has been a significant increase in drug-resistant Streptococcus pneumoniae (DRSP) due, in large part, to increased use of antimicrobials. The clinical significance of this resistance is not definitely established, but appears to be most relevant to specific MICs for specific antimicrobials. Certain beta-lactams (amoxicillin, cefotaxime, ceftriaxone), the respiratory fluoroquinolones, and telithromycin are among several agents that remain effective against DRSP. Continued surveillance studies, appropriate antimicrobial usage campaigns, stratification of patients based on known risk factors for resistance, and vaccination programmes are needed to appropriately manage DRSP and limit its spread.
File T M Jr
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
2006
2006-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1469-0691.2006.01395.x" target="_blank" rel="noreferrer noopener">10.1111/j.1469-0691.2006.01395.x</a>