The role of empiric atypical antibiotic coverage in non-severe community-acquired pneumonia

A β–lactam plus a macrolide or a respiratory fluoroquinolone alone is recommended as standard empiric antibacterial therapy for non-severe adults hospitalized with community-acquired pneumonia (CAP) per Infectious Diseases Society of America guidelines. However, the evidence in support of adding emp...

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Bibliographic Details
Main Authors: Whitney Hartlage, Hannah Imlay, Emily S. Spivak
Format: Article
Language:English
Published: Cambridge University Press 2024-01-01
Series:Antimicrobial Stewardship & Healthcare Epidemiology
Online Access:https://www.cambridge.org/core/product/identifier/S2732494X24004534/type/journal_article
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Summary:A β–lactam plus a macrolide or a respiratory fluoroquinolone alone is recommended as standard empiric antibacterial therapy for non-severe adults hospitalized with community-acquired pneumonia (CAP) per Infectious Diseases Society of America guidelines. However, the evidence in support of adding empiric atypical antibacterial therapy, and specifically the addition of a macrolide, is conflicting and should be balanced with additional factors: the necessity of covering atypical organisms, benefits of macrolide-associated immunomodulation, harms associated with antibiotic use, and selection for antibiotic-resistant organisms. In this review, we examine the role of atypical coverage in standard treatment regimens for patients admitted with non-severe CAP and specifically focus on the addition of macrolides to β–lactams. We conclude that a subset of patients should not be given atypical coverage as part of their regimen.
ISSN:2732-494X