Adult managed in the outpatient setting for community-acquired pneumonia with one or more comorbidities, including chronic heart disease, chronic lung disease, chronic liver disease, chronic renal disease, diabetes mellitus, alcoholism, malignancy, or asplenia.
Recommended management for this population involves either combination antibiotic therapy or monotherapy with a respiratory fluoroquinolone. Specific agent selection, sequencing, and duration are defined in the full structured protocol.
Achievement of clinical stability: resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, temperature), ability to eat, and normal mentation — expected within 48 to 72 hours and by 5 days.
DOI: 10.1164/rccm.201908-1581ST
For outpatient adults with comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia we recommend (in no particular order of preference) (Table 3):
Combination therapy:
Monotherapy:
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.
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