Treatment of Other Bacterial Pneumonia in Adult Outpatients with Chronic Comorbidities

This protocol applies to adults managed in the outpatient setting with community-acquired pneumonia (other bacterial aetiology) who carry one or more chronic conditions that alter the recommended antibiotic approach.

Clinical Scenario

Adult outpatient with community-acquired pneumonia and at least one of the following comorbidities:

Chronic heart disease Chronic lung disease Chronic liver disease Chronic renal disease Diabetes mellitus Alcoholism Malignancy Asplenia

Treatment Approach

Evidence-based guidelines recommend either combination antibiotic therapy or monotherapy with a respiratory fluoroquinolone — the specific agents, preferred options by comorbidity, and the full clinical algorithm are available in the structured protocol.

Treatment goal: Clinical stability — resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, temperature), ability to eat, and normal mentation — assessed by 5 days of therapy.

Instant Access to Structured Evidence-Based Regimens

References

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):

Comorbidities include chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia.

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).

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