IDSA suggests initial empiric therapy for CAP

In the 2003 recommendations for management of community-acquired pneumonia (CAP) in immunocompetent adults, the Infectious Diseases Society of America (IDSA) in Alexandria, VA, has issued suggestions for initial empiric therapy. Here are some of those suggestions:

Empiric treatment of suspected bacterial superinfection of influenza should provide activity against Staphylococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae with antibiotics such as amoxicillin-clavulanate, cefpodoxime, cefprozil, cefuroxime, or a respiratory fluoroquinolone.

Fluoroquinolones (gatifloxacin, gemifloxacin, levofloxacin, and moxifloxacin) are recommended for initial empiric therapy of selected outpatients with CAP.

Other options (macrolides and doxycycline) generally are preferred for uncomplicated infections in outpatients. Fluoroquinolones (gatifloxacin, gemifloxacin, levofloxacin, and moxifloxacin) may be used as monotherapy for patients with CAP who are admitted to a hospital ward. With the exception of gemifloxacin (no intravenous formulation), they may be used as part of a combination for patients with CAP admitted to an ICU.

A macrolide is recommended as monotherapy for selected outpatients, such as those who were previously well and not recently treated with antibiotics.

A macrolide plus a b-lactam is recommended for initial empiric treatment of outpatients in whom resistance is an issue and for hospitalized patients.

Telithromycin also may have a role as an alternative to macrolides for treatment of patients with CAP. At this time, however, the U.S. Food and Drug Administration has not yet approved it.