Current Guidelines for the Management of Adults with Community-Acquired Pneumonia: Way to a Single Standard

Clinical Microbiology and Antimicrobial Chemotherapy. 2008; 10(4):305-321

​ Guchev I.A., Sinopalnikov A.I.
community-acquired pneumonia antimicrobial therapy management guidelines
Section
Diseases and Pathogens
Type
Journal article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2008; 10(4):305-321

Abstract

Community-acquired pneumonia (CAP) is the 4-8th leading killer of people worldwide and the most leading cause of death from infections in US. This article is a review of innovations and differences between the recent American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) guidelines for the management of patients with CAP, which are based on assessment of disease severity. According to IDSA guidelines, decisions on antimicrobial therapy are guided by place of treatment (outpatient settings, general ward or intensive care unit). According to ATS guidelines, all patients with CAP should be divided into 4 groups based on presence of underlying cardiovascular and lung diseases, other risk factors for multi-drug resistant pathogens (resistant Streptococcus pneumoniae, Enterobacteriaceae and Pseudomonas aeruginosa) as well as place of treatment. Both guidelines suggest using PORT score as a tool to determine appropriate place of treatment. However, the most recent IDSA/ATS consensus guidelines recommend assessment using more available CURB/CRB-65 scores, which should be repeated within the first few hours of observation.

  • 1. National Center for Health Statistics. Health, United States, 2006, with chartbook on trends in the health of Americans. Available at: http://www.cdc.gov/nchs/data/hus/hus06.pdf. Accessed 21 February 2007.
  • 2. Mandell L.A., Wunderink R.G., Anzueto A., et al. Infectious diseases society of america/american thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(Suppl 2):S27-72.
  • 3. Miyashita N., Matsushima T., Oka M., et al. The JRS guidelines for the management of community-acquired pneumonia in adults: an update and new recommendations. Intern Med 2006; 45:419-28.
  • 4. Чучалин А.Г., Синопальников А.И., Страчунский Л.С., и соавт. Внебольничная пневмония у взрослых: практические рекомендации по диагностике, лечению и профилактике. Клин микробиол антимикроб химиотер 2006; 8:54-86.
  • 5. Antibiotic Expert Group. Therapeutic Guidelines: Antibiotic. 13 ed. North Melbourne, Australia: Therapeutic Guidelines Limited, 2006.
  • 6. Antibiotic Writing Group. Therapeutic Guidelines: Antibiotic. 12 ed. North Melbourne: Therapeutic Guidelines Limited, 2003.
  • 7. Bartlett J.G., Dowell S.F., Mandell L.A., et al. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis 2000; 31:347-82.
  • 8. Bartlett J.G., Breiman R.F., Mandell L.A., et al. Community-acquired pneumonia in adults: guidelines for management. The Infectious Diseases Society of America. Clin Infect Dis 1998; 26:811-38.
  • 9. BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Thorax 2001; 56(Suppl 4): IV1-64.
  • 10. Conference Report. Infections des voies respiratoires. Conference de consensus en therpeutique anti-infectieuse. Med Mal Infect 1991; 21:1-8.
  • 11. Dorca J., Bello S., Blanquer J., et al. [The diagnosis and treatment of community-acquired pneumonia. SEPAR. Sociedad Espanola de Neumologia y Cirugia Toracica]. Arch Bronconeumol 1997; 33:240-6.
  • 12. ERS Task Force Report. Guidelines for management of adult community-acquired lower respiratory tract infections. European Respiratory Society. Eur Respir J 1998; 11:986-91.
  • 13. Gialdroni Grassi G., Bianchi L. Guidelines for the management of community-acquired pneumonia in adults. Italian Society of Pneumology. Italian Society of Respiratory Medicine. Italian Society of Chemotherapy. Monaldi Arch Chest Dis 1995; 50:21-7.
  • 14. Guidelines for the management of community-acquired pneumonia in adults admitted to hospital. The British Thoracic Society. Br J Hosp Med 1993; 49:346-50.
  • 15. Institute for Clinical Systems Improvement (ICSI). Community-acquired pneumonia in adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 May. 36 p. 2006.
  • 16. Mandell L.A., Bartlett J.G., Dowell S.F., et al. Update of practice guidelines for the management of communityacquired pneumonia in immunocompetent adults. Clin Infect Dis 2003; 37:1405-33.
  • 17. Mandell L.A., Marrie T.J., Grossman R.F., et al. Canadian guidelines for the initial management of communityacquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. The Canadian Community-Acquired Pneumonia Working Group. Clin Infect Dis 2000; 31:383- 421.
  • 18. Niederman M.S., Mandell L.A., Anzueto A., et al. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001; 163:1730-54.
  • 19. Niederman M.S., Bass J.B., Jr., Campbell G.D., et al. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. American Thoracic Society. Medical Section of the American Lung Association. Am Rev Respir Dis 1993; 148:1418-26.
  • 20. Ramsdell J., Narsavage G.L., Fink J.B. Management of community-acquired pneumonia in the home: an American College of Chest Physicians clinical position statement. Chest 2005; 127:1752-63.
  • 21. Normativa sobre el diagnostico y tratamiento de las neumonias. Sociedad Espanola de Neumologia y Cirtugia Toracica. Barcelona, 1992.
  • 22. [The JRS guidelines for the management of community acquired pneumonia in adults]. Nihon Kokyuki Gakkai Zasshi 2007; Suppl:2-85.
  • 23. Kish M.A. Guide to development of practice guidelines. Clin Infect Dis 2001; 32:851-4.
  • 24. Dellinger R.P., Levy M.M., Carlet J.M., et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 2008; 34:17-60.
  • 25. Dean N.C., Silver M.P., Bateman K.A., et al. Decreased mortality after implementation of a treatment guideline for community-acquired pneumonia. Am J Med 2001; 110:451-7.
  • 26. Capelastegui A., Espana P.P., Quintana J.M., et al. Improvement of process-of-care and outcomes after implementing a guideline for the management of community-acquired pneumonia: a controlled before-and-after design study. Clin Infect Dis 2004; 39:955-63.
  • 27. Capelastegui A., Espana P.P., Quintana J.M., et al. [Evaluation of clinical practice in patients admitted with community-acquired pneumonia over a 4-year period]. Arch Bronconeumol 2006; 42:283-9.
  • 28. Marrie T.J., Huang J.Q. Admission is not always necessary for patients with community-acquired pneumonia in risk classes IV and V diagnosed in the emergency room. Can Respir J 2007; 14:212-6.
  • 29. Marrie T.J., Lau C.Y., Wheeler S.L., et al. A controlled trial of a critical pathway for treatment of communityacquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. Jama 2000; 283:749-55.
  • 30. Suchyta M.R., Dean N.C., Narus S., et al. Effects of a practice guideline for community-acquired pneumonia in an outpatient setting. Am J Med 2001; 110:306-9.
  • 31. Meehan T.P., Weingarten S.R., Holmboe E.S., et al. A statewide initiative to improve the care of hospitalized pneumonia patients: The Connecticut Pneumonia Pathway Project. Am J Med 2001; 111:203-10.
  • 32. Lee R.W., Lindstrom S.T. Early switch to oral antibiotics and early discharge guidelines in the management of community-acquired pneumonia. Respirology 2007; 12:111-6.
  • 33. Renaud B., Coma E., Labarere J., et al. Routine use of the Pneumonia Severity Index for guiding the siteof-treatment decision of patients with pneumonia in the emergency department: a multicenter, prospective, observational, controlled cohort study. Clin Infect Dis 2007; 44:41-9.
  • 34. Pomilla P.V., Brown R.B. Outpatient treatment of community-acquired pneumonia in adults. Arch Intern Med 1994; 154:1793-802.
  • 35. El-Solh A.A., Sikka P., Ramadan F., et al. Etiology of severe pneumonia in the very elderly. Am J Respir Crit Care Med 2001; 163:645-51.
  • 36. Fine M.J., Auble T.E., Yealy D.M., et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336:243-50.
  • 37. Garcia-Ordonez M.A., Garcia-Jimenez J.M., Paez F., et al. Clinical aspects and prognostic factors in elderly patients hospitalised for community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2001; 20:14-9.
  • 38. Luna C.M., Famiglietti A., Absi R., et al. Communityacquired pneumonia: etiology, epidemiology, and outcome at a teaching hospital in Argentina. Chest 2000; 118:1344-54.
  • 39. Meehan T.P., Chua-Reyes J.M., Tate J., et al. Process of care performance, patient characteristics, and outcomes in elderly patients hospitalized with community-acquired or nursing home-acquired pneumonia. Chest 2000; 117:1378-85.
  • 40. Roson B., Carratala J., Dorca J., et al. Etiology, reasons for hospitalization, risk classes, and outcomes of communityacquired pneumonia in patients hospitalized on the basis of conventional admission criteria. Clin Infect Dis 2001; 33:158-65.
  • 41. Charles P.G., Wolfe R., Whitby M., et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008; 47:375-84.
  • 42. Woodhead M., Blasi F., Ewig S., et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005; 26:1138-80.
  • 43. Sanguinetti C.M., De Benedetto F., Donner C.F. GP management of community-acquired pneumonia in Italy: the ISOCAP study. Monaldi Arch Chest Dis 2005; 63:23-9.
  • 44. Yealy D.M., Auble T.E., Stone R.A., et al. Effect of increasing the intensity of implementing pneumonia guidelines: a randomized, controlled trial. Ann Intern Med 2005; 143:881-94.
  • 45. Feikin D.R., Schuchat A., Kolczak M., et al. Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. Am J Public Health 2000; 90:223-9.
  • 46. Bodi M., Rodriguez A., Sole-Violan J., et al. Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America guidelines on survival. Clin Infect Dis 2005; 41:1709-16.
  • 47. Rello J., Bodi M., Mariscal D., et al. Microbiological testing and outcome of patients with severe communityacquired pneumonia. Chest 2003; 123:174-80.
  • 48. Bullowa J.G., Wilcox C. Therapeutic Serum for Pneumococcus Type V (Cooper) Pneumonia. J Clin Invest 1936; 15:711-4.
  • 49. Rosenow E.C. Studies in pneumonia and pneumococcus infection. 1904. J Infect Dis 2004; 189:132-64.
  • 50. Trask J.D., O’Donovan C., Moore D.M., et al. STUDIES ON PNEUMONIA IN CHILDREN: I. Mortality, Blood Cultures, and Humoral Antibodies in Pneumococcus Pneumonia. J Clin Invest 1930; 8:623-53.
  • 51. Niederman M.S., McCombs J.S., Unger A.N., et al. The cost of treating community-acquired pneumonia. Clin Ther 1998; 20:820-37.
  • 52. Bauer T.T., Welte T., Ernen C., et al. Cost analyses of community-acquired pneumonia from the hospital perspective. Chest 2005; 128:2238-46.
  • 53. Fine M.J., Pratt H.M., Obrosky D.S., et al. Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia. Am J Med 2000; 109:378-85.
  • 54. Jacobs P., Marrie T.J., Calder P. Private costs of patients hospitalized with community-acquired pneumonia. Can Respir J 2005; 12:205-8.
  • 55. Orrick J.J., Segal R., Johns T.E., et al. Resource use and cost of care for patients hospitalised with community acquired pneumonia: impact of adherence to infectious diseases society of america guidelines. Pharmacoeconomics 2004; 22:751-7.
  • 56. Hunt S.A. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2005; 46:e1-82.
  • 57. Venes D., Taber C.W. Taber’s cyclopedic medical dictionary. Ed. 20, illustrated in full color / ed. Philadelphia: Davis, 2005.
  • 58. Macfarlane J., Boswell T.C., Douglas G., et al. BTS Guidelines for the management of community cquired pneumonia in adults - 2004 update. Available at: http://www.britthoracic.org.uk/guidelines 2004.
  • 59. Marrie T.J. Community-acquired pneumonia. Clin Infect Dis 1994; 18:501-513; quiz 514-515.
  • 60. Pauls S., Kruger S., Richter K., et al. [Interobserver agreement in the assessment of pulmonary infiltrates on chest radiography in community-acquired pneumonia.]. Rofo 2007; 179:1152-8.
  • 61. Swingler G.H., Hussey G.D., Zwarenstein M. Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children. Lancet 1998; 351:404-8.
  • 62. Woodhead M.A., Macfarlane J.T., McCracken J.S., et al. Prospective study of the aetiology and outcome of pneumonia in the community. Lancet 1987; 1:671-4.
  • 63. Christ-Crain M., Stolz D., Bingisser R., et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006; 174:84-93.
  • 64. Muller B., Harbarth S., Stolz D., et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007; 7:10.
  • 65. Graffelman A.W., le Cessie S., Knuistingh Neven A., et al. Can history and exam alone reliably predict pneumonia? J Fam Pract 2007; 56:465-70.
  • 66. Madhi S.A., Klugman K.P. World Health Organisation definition of “radiologically-confirmed pneumonia” may under-estimate the true public health value of conjugate pneumococcal vaccines. Vaccine 2007; 25:2413-19.
  • 67. Okimoto N., Yamato K., Kurihara T., et al. Clinical predictors for the detection of community-acquired pneumonia in adults as a guide to ordering chest radiographs. Respirology 2006; 11:322-4.
  • 68. Okimoto N., Yamato K., Kurihara T., et al. [Clinical predictors for the detection of community-acquired pneumonia in adults as a guide to ordering chest radiographs]. Nihon Kokyuki Gakkai Zasshi 2004; 42:941-4.
  • 69. Saldias P.F., Mendez C.J., Ramirez R.D., et al. [Predictive value of history and physical examination for the diagnosis of community-acquired pneumonia in adults: A literature review.]. Rev Med Chil 2007; 135:517-28.
  • 70. Saldias P.F., Cabrera T.D., Solminihac L.I., et al. [Predictive value of history and physical examination for the diagnosis of community-acquired pneumonia in adults.]. Rev Med Chil 2007; 135:143-52.
  • 71. O’Brien W.T., Sr., Rohweder D.A, Lattin G.E., Jr., et al. Clinical indicators of radiographic findings in patients with suspected community-acquired pneumonia: who needs a chest x-ray? J Am Coll Radiol 2006; 3:703-6.
  • 72. Fine M.J., Hough L.J., Medsger A.R., et al. The hospital admission decision for patients with community-acquired pneumonia. Results from the pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med 1997; 157:36-44.
  • 73. Neill A.M., Martin I.R., Weir R., et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax 1996; 51:1010-6.
  • 74. Valencia M., Badia J.R., Cavalcanti M., et al. Pneumonia severity index class v patients with community-acquired pneumonia: characteristics, outcomes, and value of severity scores. Chest 2007; 132:515-22.
  • 75. Angus D.C., Marrie T.J., Obrosky D.S., et al. Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society Diagnostic criteria. Am J Respir Crit Care Med 2002; 166:717-23.
  • 76. Lee R.W., Lindstrom S.T. A teaching hospital’s experience applying the Pneumonia Severity Index and antibiotic guidelines in the management of community-acquired pneumonia. Respirology 2007; 12:754-8.
  • 77. Ananda-Rajah M.R., Charles P.G., Melvani S., et al. Comparing the pneumonia severity index with CURB65 in patients admitted with community acquired pneumonia. Scand J Infect Dis 2007:1-8.
  • 78. Lim W.S., van der Eerden M.M., Laing R., et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58:377-82.
  • 79. Kollef K.E., Reichley R.M., Micek S.T., et al. The modified apache II score outperforms curb65 pneumonia severity score as a predictor of thirty-day mortality in methicillinresistant Staphylococcus aureus pneumonia. Chest 2008; 133:363-9.
  • 80. Yan Man S., Lee N., Ip M., et al. Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong. Thorax 2007; 62:348-53.
  • 81. Chalmers J.D., Singanayagam A., Hill A.T. Systolic blood pressure is superior to other haemodynamic predictors of outcome in community acquired pneumonia. Thorax 2008; 63:698-702.
  • 82. Baudouin S.V. The pulmonary physician in critical care. 3: critical care management of community acquired pneumonia. Thorax 2002; 57:267-71.
  • 83. de Castro F.R., Torres A. Optimizing treatment outcomes in severe community-acquired pneumonia. Am J Respir Med 2003; 2:39-54.
  • 84. Neuhaus T., Ewig S. Defining severe community-acquired pneumonia. Med Clin North Am 2001; 85:1413-25.
  • 85. Seymann G., Barger K., Choo S., et al. Clinical judgment versus the Pneumonia Severity Index in making the admission decision. J Emerg Med 2008; 34:261-8.
  • 86. Musher D.M., Montoya R., Wanahita A. Diagnostic value of microscopic examination of Gram-stained sputum and sputum cultures in patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 2004; 39:165- 9.
  • 87. Baddour L.M., Yu V.L., Klugman K.P., et al. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 2004; 170:440-4.
  • 88. Chiou C.C., Yu V.L. Severe pneumococcal pneumonia: new strategies for management. Curr Opin Crit Care 2006; 12:470-6.
  • 89. Harbarth S., Nobre V., Pittet D. Does antibiotic selection impact patient outcome? Clin Infect Dis 2007; 44:87-93.
  • 90. Ho P.L., Que T.L., Ng T.K., et al. Clinical outcomes of bacteremic pneumococcal infections in an area with high resistance. Eur J Clin Microbiol Infect Dis 2006; 25:323- 7.
  • 91. Kumar A., Roberts D., Wood K.E., et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34:1589-96.
  • 92. Maimon N., Nopmaneejumruslers C., Marras T.K. Antibacterial class is not obviously important in outpatient pneumonia: a meta-analysis. Eur Respir J 2008; 31:1068-76.
  • 93. Mills G.D., Oehley M.R., Arrol B. Effectiveness of beta-lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis. BMJ 2005; 330:456.
  • 94. Marras T.K., Nopmaneejumruslers C., Chan C.K. Efficacy of exclusively oral antibiotic therapy in patients hospitalized with nonsevere community-acquired pneumonia: a retrospective study and meta-analysis. Am J Med 2004; 116:385-93.
  • 95. Martinez J.A., Horcajada J.P., Almela M., et al. Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 2003; 36:389-95.
  • 96. Waterer G.W., Somes G.W., Wunderink R.G. Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Arch Intern Med 2001; 161:1837-42.
  • 97. Weiss K., Low D.E., Cortes L., et al. Clinical characteristics at initial presentation and impact of dual therapy on the outcome of bacteremic Streptococcus pneumoniae pneumonia in adults. Can Respir J 2004; 11:589-93.
  • 98. Lodise T.P., Kwa A., Cosler L., et al. Comparison of {beta}-lactam and macrolide combination therapy versus fluoroquinolone monotherapy in hospitalized veterans affairs patients with community-acquired pneumonia. Antimicrob Agents Chemother 2007; 51:3977-82.
  • 99. Harbarth S., Garbino J., Pugin J., et al. Lack of effect of combination antibiotic therapy on mortality in patients with pneumococcal sepsis. Eur J Clin Microbiol Infect Dis 2005; 24:688-90.
  • 100. Aspa J., Rajas O., Rodriguez de Castro F., et al. Impact of initial antibiotic choice on mortality from pneumococcal pneumonia. Eur Respir J 2006; 27:1010-9.
  • 101. Yu V.L., Chiou C.C., Feldman C., et al. An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. Clin Infect Dis 2003; 37:230-7.
  • 102. Penicillin’s back: FDA raises breakpoints for S. pneumoniae pneumonia. IDSA News 2008; 18:Available from URL: http://www.idsociety.org/newsArticle. aspx?id=11010.
  • 103. Vanderkooi O.G., Low D.E., Green K., et al. Predicting antimicrobial resistance in invasive pneumococcal infections. Clin Infect Dis 2005; 40:1288-97.
  • 104. Ortiz-Ruiz G., Vetter N., Isaacs R., et al. Ertapenem versus ceftriaxone for the treatment of communityacquired pneumonia in adults: combined analysis of two multicentre randomized, double-blind studies. J Antimicrob Chemother 2004; 53(Suppl 2):ii59-66.
  • 105. Song J.H., Ko K.S., Lee M.Y., et al. In vitro activities of ertapenem against drug-resistant Streptococcus pneumoniae and other respiratory pathogens from 12 Asian countries. Diagn Microbiol Infect Dis 2006; 56:445-50.
  • 106. Amyes S.G.B., Walsh F.M., Bradley J.S. Best in class: a good principle for antibiotic usage to limit resistance development? J Antimicrob Chemother 2007; 59:825-6.
  • 107. DiNubile M.J., Chow J.W., Satishchandran V., et al. Acquisition of resistant bowel flora during a double-blind randomized clinical trial of ertapenem versus piperacillintazobactam therapy for intraabdominal infections. Antimicrob Agents Chemother 2005; 49:3217-21.
  • 108. Fritsche T.R., Stilwell M.G., Jones R.N. Antimicrobial activity of doripenem (S-4661): a global surveillance report (2003). Clin Microbiol Infect 2005; 11:974-84.
  • 109. Jones R.N., Sader H.S., Fritsche T.R. Comparative activity of doripenem and three other carbapenems tested against Gram-negative bacilli with various betalactamase resistance mechanisms. Diagn Microbiol Infect Dis 2005; 52:71-4.
  • 110. Ge Y., Wikler M.A., Sahm D.F., et al. In vitro antimicrobial activity of doripenem, a new carbapenem. Antimicrob Agents Chemother 2004; 48:1384-96.
  • 111. Contopoulos-Ioannidis D.G, Ioannidis J.P., Chew P., et al. Meta-analysis of randomized controlled trials on the comparative efficacy and safety of azithromycin against other antibiotics for lower respiratory tract infections. J Antimicrob Chemother 2001; 48:691-703.
  • 112. Swainston Harrison T., Keam S.J. Azithromycin Extended Release : A review of its use in the treatment of acute bacterial sinusitis and community-acquired pneumonia in the US. Drugs 2007; 67:773-92.
  • 113. Li J.Z., Winston L.G., Moore D.H., et al. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med 2007; 120:783- 90.
  • 114. Agarwal G., Awasthi S., Kabra S.K., et al. Three day versus five day treatment with amoxicillin for non-severe pneumonia in young children: a multicentre randomised controlled trial. BMJ 2004; 328:791.
  • 115. Pakistan Multicentre Amoxycillin Short Course Therapy (MASCOT) Pneumonia Study Group. Clinical efficacy of 3 days versus 5 days of oral amoxicillin for treatment of childhood pneumonia: a multicentre double-blind trial. Lancet 2002; 360:835-41.
  • 116. el Moussaoui R., de Borgie C.A., van den Broek P., et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderatesevere community acquired pneumonia: randomised, double blind study. BMJ 2006; 332:1355.
  • 117. Peltola H., Vuori-Holopainen E., Kallio M.J. Successful shortening from seven to four days of parenteral betalactam treatment for common childhood infections: a prospective and randomized study. Int J Infect Dis 2001; 5:3-8.
  • 118. Montravers P., Fagon J.Y., Chastre J., et al. Followup protected specimen brushes to assess treatment in nosocomial pneumonia. Am Rev Respir Dis 1993; 147:38- 44.
  • 119. Opal S.M., Garber G.E., LaRosa S.P., et al. Systemic host responses in severe sepsis analyzed by causative microorganism and treatment effects of drotrecogin alfa (activated). Clin Infect Dis 2003; 37:50-8.
  • 120. Arancibia F., Ewig S., Martinez J.A., et al. Antimicrobial treatment failures in patients with community-acquired pneumonia: causes and prognostic implications. Am J Respir Crit Care Med 2000; 162:154-60.
  • 121. Ortquist A., Kalin M., Lejdeborn L., et al. Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia. Chest 1990; 97:576-82.
  • 122. El Solh A.A., Aquilina A.T., Gunen H., et al. Radiographic resolution of community-acquired bacterial pneumonia in the elderly. J Am Geriatr Soc 2004; 52:224-9.
  • 123. Fein A.M., Feinsilver S.H., Niederman M.S. Nonresolving and slowly resolving pneumonia. Diagnosis and management in the elderly patient. Clin Chest Med 1993; 14:555-69.
  • 124. Kuru T., Lynch J.P.I. Nonresolving, slowly resolving, and recurrent pneumonia: infectious etiologies and noninfectious mimics. In: Niederman M, Sarosi GA, Glassroth J, eds. Respiratory infections. New York: Lippincott Williams and Wilkins, 2001; 317-31.
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