This protocol covers hospitalised adults with nonsevere community-acquired pneumonia (CAP) who do not have risk factors for MRSA or Pseudomonas aeruginosa. In this population, empiric antibiotic selection is guided by the nonsevere inpatient setting and the absence of these specific resistant-organism risk factors.
Management involves combination antibiotic therapy or, in appropriate patients, monotherapy — the specific agents and the alternative approach for patients with certain drug contraindications are laid out in the structured protocol.
Clinical stability is the primary endpoint: resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature), ability to eat, and normal mentation. Most patients are expected to reach stability within 48 to 72 hours, and within 5 days overall.
DOI: 10.1164/rccm.201908-1581ST
In inpatient adults with nonsevere CAP without risk factors for MRSA or P. aeruginosa (see Recommendation 11), we recommend the following empiric treatment regimens (in no order of preference) (Table 4).
As recent data supporting antibiotic administration for <5 days are scant, on a risk–benefit basis we recommend treating for a minimum of 5 days, even if the patient has reached clinical stability before 5 days.
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.
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