علاج التهاب الرئة بالمستدمية النزلية في العيادات الخارجية لدى البالغين الأصحاء بدون أمراض مصاحبة

References

DOI: 10.1164/rccm.201908-1581ST

• For healthy outpatient adults without comorbidities listed below or risk factors for antibiotic resistant pathogens, we recommend (Table 3):
• Comorbidities include chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia.
• Risk factors include prior respiratory isolation of MRSA or P. aeruginosa or recent hospitalization AND receipt of parenteral antibiotics (in the last 90 d).
• amoxicillin 1 g three times daily (strong recommendation, moderate quality of evidence), or
• doxycycline 100 mg twice daily (conditional recommendation, low quality of evidence), or
• a macrolide (azithromycin 500 mg on first day then 250 mg daily or clarithromycin 500 mg twice daily) only in areas with pneumococcal resistance to macrolides <25% (conditional recommendation, moderate quality of evidence).
• We recommend that the duration of antibiotic therapy should be guided by a validated measure of clinical stability (resolution of vital sign abnormalities [heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature], ability to eat, and normal mentation), and antibiotic therapy should be continued until the patient achieves stability and for no less than a total of 5 days (strong recommendation, moderate quality of evidence).
• As most patients will achieve clinical stability within the first 48 to 72 hours, a total duration of therapy of 5 days will be appropriate for most patients.