Community-acquired pneumonia: Update on antibiotic therapy

For patients with mild to moderately severe community-acquired pneumonia, a routine clinical assessment and a chest film are indicated, but Gram's staining and culturing of sputum are of limited value. We use an empiric approach to therapy that is hosed on age, co-morbid conditions, severity of illness, and whether hospitalization is required. For patients younger than 60 years who do not need to be admitted, macrolides are the treatment of choice. For those age 60 or older, as well as younger patients with co-morbid conditions, we recommend a second-generation cephalosparin or a β-lactam/β-lactamase inhibitor combination. For those who require hospitalization, consider a second- or third-generation cephalosporin or a β-lactam/β-lactamase inhibitor combination. Finally, for seriously ill patients in the ICU, we recommend an intravenous macrolide plus a third- generation cephalosparin with antipseudomonal activity or another antipseudomonal agent, such as ciprofloxacin or imipenem/cilastatin. These recommendations are not intended for patients who have HIV infection/AIDS or who are receiving immunosuppressive drugs.