American Thoracic Society
Diagnosis and Management of Adults with Community-Acquired Pneumonia
Ce document comprend 10 recommandations, 141 références et 6 tableaux.
Contenu en anglais
Synthèse
Understanding of the diagnosis and treatment of adults with community-acquired pneumonia (CAP) has evolved. This document updates evidence-based clinical practice guidelines on four key questions: LUS versus chest radiography, empiric antibacterial therapy with positive respiratory virus testing, antibiotic duration, and systemic corticosteroids.
Messages clés
Lung ultrasound is an acceptable alternative to chest radiography for CAP diagnosis if local clinical expertise is available.
For viral CAP, empiric antibiotics are not suggested for outpatients without comorbidities, but are suggested for outpatients with comorbidities and all hospitalized patients.
Antibiotic therapy can safely be reduced to less than 5 days (minimum 3 days) for outpatients and nonsevere inpatients reaching early clinical stability.
Antibiotics for 5 or more days remain recommended for severe CAP.
Systemic corticosteroids are conditionally recommended for patients hospitalized with severe CAP (excluding influenza) but strongly recommended against for nonsevere CAP.
Nouveautés de cette version
Updates the 2019 guidelines by answering two new clinical questions (lung ultrasound vs. chest radiography, and empiric antibiotics for viral pneumonia) and updating two existing clinical questions (duration of antibiotics, and use of systemic corticosteroids).
Recommandations
1. Lung ultrasound versus chest radiography to diagnose CAP
For adults with suspected CAP, we suggest lung ultrasound is an acceptable diagnostic alternative to chest radiography in medical centers where appropriate clinical expertise exists.
Patients concernés: adults with suspected CAPSituation: suspected CAP
2. Empiric antibacterial therapy for CAP with positive respiratory virus testing
For adult outpatients without comorbidities who have clinical and imaging evidence of CAP and who have a positive test result for a respiratory virus, we suggest not prescribing empiric antibiotics.
Patients concernés: adult outpatients without comorbiditiesSituation: CAP with positive respiratory virus
For adult outpatients with comorbidities who have clinical and imaging evidence of CAP and who have a positive test result for a respiratory virus, we suggest prescribing empiric antibiotics because of concern for bacterial-viral coinfection.
Patients concernés: adult outpatients with comorbiditiesSituation: CAP with positive respiratory virus
For adult inpatients with clinical and imaging evidence of nonsevere CAP who have a positive test result for a respiratory virus, we suggest prescribing empiric antibiotics because of concern for bacterial-viral coinfection.
Patients concernés: adult inpatients with nonsevere CAPSituation: CAP with positive respiratory virus
For adult inpatients with clinical and imaging evidence of severe CAP who have a positive test result for a respiratory virus, we suggest prescribing empiric antibiotics because of concern for bacterial-viral coinfection.
Patients concernés: adult inpatients with severe CAPSituation: CAP with positive respiratory virus
3. Antibiotic duration for CAP
For adult outpatients with CAP who reach clinical stability, we suggest less than 5 days of antibiotics (minimum of 3-d duration) rather than 5 or more days of antibiotics.
Patients concernés: adult outpatients with CAP who reach clinical stabilitySituation: CAP
For adult inpatients with nonsevere CAP who reach clinical stability, we suggest less than 5 days of antibiotics (minimum of 3-d duration) rather than 5 or more days of antibiotics.
Patients concernés: adult inpatients with nonsevere CAP who reach clinical stabilitySituation: CAP
For adult inpatients with severe CAP who reach clinical stability, we suggest 5 or more days of antibiotics rather than less than 5 days of antibiotics.
Patients concernés: adult inpatients with severe CAP who reach clinical stabilitySituation: CAP
