Treatment of Staphylococcus aureus pneumonia in adults hospitalised with severe community-acquired pneumonia
First-line · Inpatient · Severe CAP
This protocol applies to adults admitted to hospital with severe community-acquired pneumonia (CAP) — defined by one major criterion or three or more minor criteria — in whom there is no prior respiratory isolation of MRSA or Pseudomonas aeruginosa.
Clinical Situation
The patient meets the severity threshold for severe CAP and has no prior history of resistant-organism isolation. This combination — documented severity with absent resistant-pathogen risk — defines the specific population addressed by the evidence below.
Treatment Approach
The protocol centres on a β-lactam antibiotic combined with either a macrolide or a respiratory fluoroquinolone. Specific agent choice, criteria for switching from parenteral to oral therapy, and full duration guidance are contained in the structured protocol.
Clinical Goals
Success is defined as clinical stability: normalisation of heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature, together with ability to eat and normal mentation. Most patients reach this endpoint within the first 48 to 72 hours.
References
DOI: 10.1164/rccm.201908-1581ST
- In inpatient adults with severe CAP (see Table 1) without risk factors for MRSA or P. aeruginosa, we recommend (Table 4) (note, specific agents and doses are the same as 9.1):
- a b-lactam plus a macrolide (strong recommendation, moderate quality of evidence); or
- a b-lactam plus a respiratory fluoroquinolone (strong recommendation, low quality of evidence).
- In switching from parenteral to oral antibiotics, either the same agent or the same drug class should be used.
- 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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