Treatment of community-acquired pneumonia - IDSA guidelines
Treatment of community-acquired pneumonia - IDSA guidelines
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DOI：
10.1378/chest.115.suppl_1.9s
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发表时间：
1999-03-01
期刊：
影响因子：
9.6
通讯作者：
Bernstein, JM
中科院分区：
文献类型：
--
作者：
Bernstein, JM
美国传染病协会（IDSA）发布了社区获得性肺炎（CAP）的治疗指南。虽然肺炎链球菌仍然是最常见的病原体，肺炎衣原体和嗜肺军团菌也是重要的原因。对于所有疑似CAP患者，特别是需要住院治疗的患者，强烈建议进行胸部X线检查以确诊。与美国胸科学会发布的指南相反，IDSA指南强调在可能的情况下，对所有患者进行痰革兰氏染色和培养，以确定病因。这些信息不仅可用于指导治疗，还可用于跟踪CAP病原体及其抗生素敏感性的趋势。鉴于尽早干预的结果更好，IDSA建议初始经验性抗菌治疗，直到获得实验室结果以指导更具体的治疗。大环内酯类、多西环素和氟喹诺酮类被建议用于主要的经验性治疗，因为每种药物都对常见的细菌病原体和非典型病原体有活性。针对各种病原体提出了详细的抗生素建议。对于住院病人，应尽量涵盖军团菌和其他常见致病菌。对于肺部结构性疾病、青霉素过敏或疑似吸入性肺炎的患者，建议使用替代抗生素。一旦患者的病情稳定，并且他或她可以耐受口服治疗，建议立即改用适当的口服抗生素，通常在72小时内。
The Infectious Diseases Society of America (IDSA) has published guidelines for the treatment of community-acquired pneumonia (CAP). Although Streptococcus pneumoniae remains the most common etiologic agent, Chlamydia pneumoniae and Legionella pneumophila are also important causes. For all suspected CAP patients, particularly those requiring hospitalization, chest radiographs are strongly recommended to confirm the diagnosis. The IDSA guidelines, in contrast to those published by the American Thoracic Society, emphasize the use of sputum Gram's stain and culture in all patients, whenever possible, to establish etiology. This information can be used not only to guide therapy but also to track trends in the etiologic pathogens for CAP and their antibiotic susceptibility. In light of the better outcomes with the earliest possible interventions, the IDSA recommends initial empiric antimicrobial therapy until laboratory results can be obtained to guide more specific therapy. Macrolides, doxycycline, and fluoroquinolones are suggested for primary empiric therapy, since each has activity against common bacterial pathogens and atypical agents. Detailed antibiotic recommendations are made for various pathogens. For inpatients, attempts should be made to cover Legionella and other common pathogenic bacteria. Alternative antibiotics are recommended for patients with structural diseases of the lung, penicillin allergy, or suspected aspiration pneumonia. Switch to an appropriate oral antibiotic is recommended as soon as the patient's condition is stable and he or she can tolerate oral therapy, often within 72 h.