Management of Community-Acquired Pneumonia in the Era of Pneumococcal Resistance

摘要: Objective To provide recommendations for the management of community-acquired pneumonia and surveillance drug-resistant Streptococcus pneumoniae (DRSP). Methods We addressed following questions: (1) Should pneumococcal resistance to β-lactam antimicrobial agents influence treatment? (2) What are suitable empirical regimens outpatient treatment in DRSP era? (3) hospitalized patients with (4) How should clinical laboratories report antibiotic susceptibility patterns for, S what drugs be included if is syndrome interest? Experts Therapeutic Working Group, which includes clinicians, academicians, public health practitioners, met at Centers Disease Control Prevention March 1998 discuss era DRSP. Published unpublished data were summarized from scientific literature experience participants. After group presentations review background materials, subgroup chairs prepared draft responses, discussed as a group. Conclusions When implicated cases pneumonia, considered susceptible penicillin minimum inhibitory concentration (MIC) no greater than 1 µg/mL, intermediate MIC 2 resistant less 4 µg/mL. For oral include macrolide (eg, erythromycin, clarithromycin, azithromycin), doxycycline (or tetracycline) children aged 8 years or older, an good activity against pneumococci cefuroxime axetil, amoxicillin, combination amoxicillin clavulanate potassium). Suitable inpatient intravenous β-lactam, such cefuroxime, ceftriaxone sodium, cefotaxime ampicillin sodium sulbactam plus macrolide. New fluoroquinolones improved can also used treat adults pneumonia. limit emergence fluoroquinolone-resistant strains, new limited whom one above has already failed, who allergic alternative agents, have documented infection highly ≥4 µg/mL). Vancomycin hydrochloride not routinely indicated caused by