This protocol addresses adults admitted to hospital with severe community-acquired pneumonia (CAP) — defined by at least one major criterion or three or more minor IDSA/ATS criteria.
It applies specifically when the following conditions are met:
The recommended strategy for this population involves combination antibiotic therapy — a beta-lactam paired with a second antibiotic class. Two combination options are supported by guideline evidence. Specific agents, dosing, and sequencing are detailed in the full protocol.
The treatment target is clinical stability: 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 the first 48 to 72 hours, with antibiotic therapy continued for no less than a total of 5 days.
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):
Validated definition includes either one major criterion or three or more minor criteria.
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).
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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