IDWeek 2019 — 2019 guidelines for treating community-acquired pneumonia are updated


  • Marielle Fares, Pharm.D.
  • Conference Reports
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Takeaway

  • The 2019 Infectious Diseases Society of America/American Thoracic Society have updated their guidelines for treating community-acquired pneumonia (CAP).
  • Key updates include not to withhold initial therapy based on procalcitonin, a strong recommendation for beta-lactam monotherapy for outpatients, and no routine steroids unless inflammatory response is high.

Why this matters

  • Prior to publication of the 2007 CAP guideline, antibiotics were inappropriately used.  

Key recommendations

  • For outpatients:  
    • Macrolides are associated with decreased mortality when compared with quinolones.
    • If no comorbidities or risk factors for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa:
      • Amoxicillin, doxycycline, or macrolide (if local pneumococcal resistance is
    • With comorbidities:
      • Amoxicillin/clavulanate or cephalosporin + macrolide or doxycycline, or monotherapy with fluoroquinolone.
    • Support for quinolone monotherapy.
  • For inpatients:
    • Beta-lactams are not recommended in monotherapy but in combination with macrolides.
      • Beta-lactam + macrolide, or fluoroquinolone.
      • Beta-lactam + macrolide or fluoroquinolone if severe pneumonia.
  • Suggested other "minor" criteria for severe CAP:
    • Hyponatremia, thrombocytosis, and abnormal arterial CO2. 
  • Areas of uncertainty:
    • The role of antitoxin therapy (linezolid, clindamycin, or rifampin) for CAP MRSA. 
    • Optimal therapy for aspiration pneumonia.
    • Role of macrolides in severe CAP.
    • Role of new antibiotics omadacycline and lefamulin.
  • The above is a synopsis, and clinicians should consult the complete guidelines for details.