Guidelines for the Treatment of Community-Acquired Pneumonia
Community-acquired pneumonia (CAP) is a common cause of death and disability among people living with HIV. CAP is a major public health problem worldwide and has a high mortality rate.
The treatment of CAP depends on the type of pneumonia and the cause. For example, bacterial pneumonia requires antibiotics to treat the infection.
Antimicrobial therapy is a key component of treatment for community-acquired pneumonia. It involves the use of empirically selected antibiotics that are rapidly started to reduce symptoms, minimize the duration of hospitalization, and prevent complications.
The main goals of antibiotic treatment are to identify the pathogen and kill it. The decision to start antimicrobial therapy depends on the type of infection and its severity, as well as the pattern of local antibiotic resistance and other patient-specific factors.
The most common pathogens in community-acquired pneumonia are Streptococcus pneumoniae, Haemophilus influenzae, and atypical bacteria such as Chlamydia pneumoniae. Viruses are also associated with community-acquired pneumonia.
When appropriate, respiratory support can improve the outcome of community-acquired pneumonia. It can help maintain oxygenation and pulmonary function, prevent hypoxia, and reduce hospital admissions.
Patients with community-acquired pneumonia may have fever, cough, dyspnea, rigors, or chest pain. The etiology is typically bacterial but can also be viral.
Treatment for CAP is empirical and usually consists of antibiotics such as macrolides, fluoroquinolones, or doxycycline. The antibiotics are usually administered through parenteral routes. They should be switched to oral antibiotics once symptoms have improved, the patient is afebrile, and they can tolerate oral medications.
The treatment of CAP is guided by a combination of prognostic scoring and outcome assessment tools, such as the Pneumonia Severity Index (PSI) or CURB-65 score, along with clinical judgment. These tools have been proven to be safe and effective in guiding clinical decision-making.
Severe pneumonia remains a frequent cause of hospitalization and may result in sepsis, requiring admission to the intensive care unit. Mortality rates in patients with CAP remain high, especially in those with chronic disease and severe comorbidities.
The primary etiology of severe pneumonia is typically bacterial (see table: Risk Stratification for Community-Acquired Pneumonia). Viral infections are now recognized as a significant cause of CAP, accounting for 18–30% of cases.
Necrotizing pneumonia is a rare but increasing complication of pediatric CAP, often seen in children who fail to respond to empiric therapy. Symptoms include high fever, tachypnea, tachycardia, and respiratory distress.
Inpatient testing is recommended in children with moderate-to-severe CAP, including blood cultures and chest x-rays. Viral testing is particularly useful in children with influenza-like illness and in those who have undergone pneumococcal vaccines.
Community-acquired pneumonia (CAP) is a respiratory infection that is mainly due to the failure of immune mechanisms to control invading microorganisms. CAP is caused by bacteria, viruses, and mycoplasma.
When bacteria enter the lung, they must compete with resident microbes to survive and replicate. As a result, the alveoli fill with fluid, which inhibits the lung's ability to take in oxygen. This results in dyspnea, fever, chest pains, and cough.
Symptoms usually appear within 7 days after the infection begins, although they may be worse for a short time before improving. Antibiotics are used to treat CAP.
Patients who are hospitalized for CAP should be given empiric antibiotic therapy in the form of macrolides, fluoroquinolones, or doxycycline. They should then be switched to oral antibiotics if they improve, become afebrile, and are able to tolerate oral medications. This strategy has been shown to be effective in reducing unnecessary hospitalizations for CAP and minimizing complications.