Empiric treatment of ambulatory community-acquired pneumonia: always include treatment for atypical agents

Marrie, Thomas J.

doi:10.1016/j.idc.2004.07.002

Cited by 12 publications

(10 citation statements)

References 77 publications

(70 reference statements)

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“…Because doxycycline displays concentration-dependent killing kinetics at high dose, it may also be administered as a single daily dose of 400 mg (IV ⁄ PO) every 24 h as part of the 3-day loading regimen or as 200 mg (IV ⁄ PO) for completion of therapy. To the best of my knowledge, there has not been a therapeutic failure using doxycycline when administered with a loading regimen in treating even severe Legionella CAP [4][5][6][68][69][70][71][72][73][74][75][76].…”

Section: Doxycyclinementioning

confidence: 99%

The atypical pneumonias: clinical diagnosis and importance

Cunha

2006

Clinical Microbiology and Infection

217

153

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The most common atypical pneumonias are caused by three zoonotic pathogens, Chlamydia psittaci (psittacosis), Francisella tularensis (tularemia), and Coxiella burnetii (Q fever), and three nonzoonotic pathogens, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella. These atypical agents, unlike the typical pathogens, often cause extrapulmonary manifestations. Atypical CAPs are systemic infectious diseases with a pulmonary component and may be differentiated clinically from typical CAPs by the pattern of extrapulmonary organ involvement which is characteristic for each atypical CAP. Zoonotic pneumonias may be eliminated from diagnostic consideration with a negative contact history. The commonest clinical problem is to differentiate legionnaire's disease from typical CAP as well as from C. pneumoniae or M. pneumonia infection. Legionella is the most important atypical pathogen in terms of severity. It may be clinically differentiated from typical CAP and other atypical pathogens by the use of a weighted point system of syndromic diagnosis based on the characteristic pattern of extrapulmonary features. Because legionnaire's disease often presents as severe CAP, a presumptive diagnosis of Legionella should prompt specific testing and empirical anti-Legionella therapy such as the Winthrop-University Hospital Infectious Disease Division's weighted point score system. Most atypical pathogens are difficult or dangerous to isolate and a definitive laboratory diagnosis is usually based on indirect, i.e., direct flourescent antibody (DFA), indirect flourescent antibody (IFA). Atypical CAP is virtually always monomicrobial; increased IFA IgG tests indicate past exposure and not concurrent infection. Anti-Legionella antibiotics include macrolides, doxycycline, rifampin, quinolones, and telithromycin. The drugs with the highest level of anti-Legionella activity are quinolones and telithromycin. Therapy is usually continued for 2 weeks if potent anti-Legionella drugs are used. In adults, M. pneumoniae and C. pneumoniae may exacerbate or cause asthma. The importance of the atypical pneumonias is not related to their frequency (approximately 15% of CAPs), but to difficulties in their diagnosis, and their nonresponsiveness to beta-lactam therapy. Because of the potential role of C. pneumoniae in coronary artery disease and multiple sclerosis (MS), and the role of M. pneumoniae and C. pneumoniae in causing or exacerbating asthma, atypical CAPs also have public health importance.

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Section: Doxycyclinementioning

confidence: 99%

The atypical pneumonias: clinical diagnosis and importance

Cunha

2006

Clinical Microbiology and Infection

217

153

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“…Risk factors for CAP include advanced age, chronic obstructive pulmonary disease, renal insufficiency, congestive heart failure, malignancy, diabetes, and alcoholism [5]. The etiologic organism in CAP is undetermined in 50% of cases [6]. Some of the more common organisms that cause CAP and the radiographic appearances are discussed below.…”

Section: Community Acquiredmentioning

confidence: 99%

“…Mycoplasma pneumoniae is the most common pathogen of this group. It also is one of the most commonly identified agents in CAP and causes 20% to 30% of infections [6]. Mycoplasma is the smallest free-living culturable organism and shares some similarities with bacteria; however, it lacks a cell wall.…”

Section: Atypical Pneumoniamentioning

confidence: 99%

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Acute Lung Infections in Normal and Immunocompromised Hosts

Waite¹,

Jeudy²,

White³

2006

Radiologic Clinics of North America

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Pulmonary infections are among the most common causes of morbidity and mortality worldwide, and contribute substantially to annual medical expenditures in the United States. Despite the availability of antimicrobial agents, pneumonia constitutes the sixth most common cause of death and the number one cause of death from infection. Pneumonia can be particularly life-threatening in the elderly, in individuals who have pre-existing heart and lung conditions, in patients who have suppressed or weakened immunity, and in pregnant women. This article discusses some of the important causes of acute lung infections in normal and immunocompromised hosts. Because there often is considerable overlap, infections are categorized by the host immune status that is most likely to be associated with a particular pathogen.

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“…We audited prescribing practices in the emergency department (ED), and over the first 24 h of care, to identify the problems with empiric antibiotic prescribing for adults with community‐acquired pneumonia that were likely to be of most clinical significance for the patient. We were particularly interested in the early provision of antibiotic coverage for the likely bacterial pathogens, selection of antibiotics to accommodate known patient allergies and early broad‐spectrum empiric antibiotics for the patients who were most severely ill, as recommended in recent guidelines 1–5 …”

Section: Introductionmentioning

confidence: 99%