Journal List > Tuberc Respir Dis > v.67(4) > 1001425

Song, Jung, Kang, Kim, Pai, Suh, Shim, Ahn, Ahn, Woo, Lee, Lee, Lee, Lee, Lee, Lee, Chung, and A Joint committee for CAP Treatment Guideline: Treatment Guidelines for Community-acquired Pneumonia in Korea: An Evidence-based Approach to Appropriate Antimicrobial Therapy

Abstract

The successful treatment of community-acquired pneumonia requires appropriate, empirical antimicrobial therapy. The etiology and antimicrobial susceptibility of major pneumonia pathogens can differ by country. Therefore, the ideal treatment guidelines for community-acquired pneumonia should be based on the studies performed in each country. We developed a treatment guideline for community-acquired pneumonia for immunocompetent adults in Korea. This guideline was developed by the joint committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory diseases.

Figures and Tables

Table 1
Grading levels of evidence
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Table 2
Criteria for admission: pneumonia severity index (PSI) score
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*Coexisting illness (Neoplastic disease: within one year, excluding cutaneous basal cell carcinoma or cutaneous squamous cell carcinoma; Liver disease: clinical or histological liver cirrhosis or chronic active hepatitis; Congestive cardiac failure: diagnosed by history, physical examination or laboratory findings; Cerebrovascular disease: clinical stroke or confirmed cases by CT or MRI), Altered mental state: disorientation to person, place and time; or recently decreased level of consciousness.

Table 3
Expected mortality, risk, and recommended place for treatment according to PSI
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*Hospitalization for a short term or treatment at observation unit.

Table 4
CURB-65, mortality, risk, and recommended place for treatment
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Table 5
Criteria for severe pneumonia
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Table 6
Checklist for decision of discharge
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Table 7
Major pathogens of community-acquired pneumonia in Korea
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Table 8
Etiologies according to severity
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*Others: M. tuberculosis, Orientia tsutsugamushi, Leptospira.

Table 9
Etiologies according to the risk factors
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Table 10
Pathogen distribution of atypical pneumonia in Korea
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ND: not done.

Table 11
Etiology of viral pneumonia in Korea
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*Virus was isolated in 10.1% of community-acquired pneumonia.

Table 12
Recommended antimicrobial therapy according to etiologic microorganism
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FQ: fluoroquinolone.

Table 13
Recommended dosage, merits and demerits*
trd-67-281-i013

*Antimicrobial agents recommended in empirical therapy were described. In general, dosages were based on the guidelines of Korea Food & Drug Administration.

Table 14
Causes of pneumonia with no response to antimicrobial therapy
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References

1. Korea National Statistical Office. Annual report on the cause of death statistics 2007: Nationwide. 2007. Daejeon: Korea National Statistical Office.
2. Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA. 2000. 283:749–755.
3. Waterer GW, Wunderink RG. The influence of the severity of community-acquired pneumonia on the usefulness of blood cultures. Respir Med. 2001. 95:78–82.
4. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, 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–S72.
5. Jefferson H, Dalton HP, Escobar MR, Allison MJ. Transportation delay and the microbiological quality of clinical specimens. Am J Clin Pathol. 1975. 64:689–693.
6. Yzerman EP, den Boer JW, Lettinga KD, Schellekens J, Dankert J, Peeters M. Sensitivity of three urinary antigen tests associated with clinical severity in a large outbreak of Legionnaires' disease in The Netherlands. J Clin Microbiol. 2002. 40:3232–3236.
7. Rosón B, Fernández-Sabé N, Carratalà J, Verdaguer R, Dorca J, Manresa F, et al. Contribution of a urinary antigen assay (Binax NOW) to the early diagnosis of pneumococcal pneumonia. Clin Infect Dis. 2004. 38:222–226.
8. Kim S, Sung H, Kim DJ, Kim MN. Clinical relevance of positive NOW (TM) legionella urinary antigen test in a tertiary-care hospital in Korea. Korean J Lab Med. 2006. 26:93–97.
9. van der Eerden MM, Vlaspolder F, de Graaff CS, Groot T, Bronsveld W, Jansen HM, et al. Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study. Thorax. 2005. 60:672–678.
10. Lee JS, Chung JW, Koh Y, Lim CM, Jung YJ, Oh YM, et al. The etiologies and initial antimicrobial therapy outcomes in one tertiary hospital ICU-admitted patient with severe community-acquired pneumonia. Tuberc Respir Dis. 2005. 59:522–529.
11. Campbell SG, Marrie TJ, Anstey R, Dickinson G, Ackroyd-Stolarz S. The contribution of blood cultures to the clinical management of adult patients admitted to the hospital with community-acquired pneumonia: a prospective observational study. Chest. 2003. 123:1142–1150.
12. Hahn TH, Jang MK, Kim SG, Lee JY, Lee JM, Kim DK, et al. The usefulness of quantitative culture of bronchoalveolar lavage fluid in the diagnosis of bacterial pneumonia. Korean J Med. 1998. 54:820–826.
13. Smith MD, Derrington P, Evans R, Creek M, Morris R, Dance DA, et al. Rapid diagnosis of bacteremic pneumococcal infections in adults by using the Binax NOW Streptococcus pneumoniae urinary antigen test: a prospective, controlled clinical evaluation. J Clin Microbiol. 2003. 41:2810–2813.
14. Murdoch DR, Laing RT, Cook JM. The NOW S. pneumoniae urinary antigen test positivity rate 6 weeks after pneumonia onset and among patients with COPD. Clin Infect Dis. 2003. 37:153–154.
15. Labarere J, Stone RA, Obrosky DS, Yealy DM, Meehan TP, Fine JM, et al. Comparison of outcomes for low-risk outpatients and inpatients with pneumonia: a propensity-adjusted analysis. Chest. 2007. 131:480–488.
16. Alikhan R, Cohen AT, Combe S, Samama MM, Desjardins L, Eldor A, et al. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: analysis of the MEDENOX Study. Arch Intern Med. 2004. 164:963–968.
17. Minogue MF, Coley CM, Fine MJ, Marrie TJ, Kapoor WN, Singer DE. Patients hospitalized after initial outpatient treatment for community-acquired pneumonia. Ann Emerg Med. 1998. 31:376–380.
18. Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A, Epton MJ, et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax. 1996. 51:1010–1016.
19. Labarere J, Stone RA, Scott Obrosky D, Yealy DM, Meehan TP, Auble TE, et al. Factors associated with the hospitalization of low-risk patients with community-acquired pneumonia in a cluster-randomized trial. J Gen Intern Med. 2006. 21:745–752.
20. Bae JH, Lee MJ, Oh DR, Lee WJ, Kim SK. Modified triage method by pneumonia severity index for patients with community: acquired pneumonia. J Korean Soc Emerg Med. 2002. 13:129–134.
21. Choi SO, Park MS, Kang MH, Lee MK. Evaluation of risk factors for hospitalization and comparison of empiricregimens for efficacy and toxicity to treat community-acquired pneumonia. J Korean Soc Health Syst Pharm. 2005. 22:36–45.
22. Bont J, Hak E, Hoes AW, Schipper M, Schellevis FG, Verheij TJ. A prediction rule for elderly primary-care patients with lower respiratory tract infections. Eur Respir J. 2007. 29:969–975.
23. Fine MJ, Hough LJ, Medsger AR, Li YH, Ricci EM, Singer DE, 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.
24. Yealy DM, Auble TE, Stone RA, Lave JR, Meehan TP, Graff LG, et al. Effect of increasing the intensity of implementing pneumonia guidelines: a randomized, controlled trial. Ann Intern Med. 2005. 143:881–894.
25. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003. 58:377–382.
26. Teramoto S, Yamamoto H, Yamaguchi Y, Hanaoka Y, Ishii M, Hibi S, et al. Lower respiratory tract infection outcomes are predicted better by an age >80 years than by CURB-65. Eur Respir J. 2008. 31:477–478.
27. Aujesky D, Auble TE, Yealy DM, Stone RA, Obrosky DS, Meehan TP, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med. 2005. 118:384–392.
28. Foley SC, Kelly EM, O'Neill SJ. Audit of the management of patients admitted with community acquired pneumonia. Ir Med J. 2006. 99:138–140.
29. Angus DC, Marrie TJ, Obrosky DS, Clermont G, Dremsizov TT, Coley C, 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. 166:717–723.
30. Ananda-Rajah MR, Charles PG, Melvani S, Burrell LL, Johnson PD, Grayson ML. Comparing the pneumonia severity index with CURB-65 in patients admitted with community acquired pneumonia. Scand J Infect Dis. 2008. 40:293–300.
31. Marrie TJ, Huang JQ. 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. 14:212–216.
32. Valencia M, Badia JR, Cavalcanti M, Ferrer M, Agusti C, Angrill J, et al. Pneumonia severity index class v patients with community-acquired pneumonia: characteristics, outcomes, and value of severity scores. Chest. 2007. 132:515–522.
33. Ewig S, Ruiz M, Mensa J, Marcos MA, Martinez JA, Arancibia F, et al. Severe community-acquired pneumonia. Assessment of severity criteria. Am J Respir Crit Care Med. 1998. 158:1102–1108.
34. Ramirez JA. Switch therapy in community-acquired pneumonia. Diagn Microbiol Infect Dis. 1995. 22:219–223.
35. Ramirez JA, Vargas S, Ritter GW, Brier ME, Wright A, Smith S, et al. Early switch from intravenous to oral antibiotics and early hospital discharge: a prospective observational study of 200 consecutive patients with community-acquired pneumonia. Arch Intern Med. 1999. 159:2449–2454.
36. Ramirez JA, Bordon J. Early switch from intravenous to oral antibiotics in hospitalized patients with bacteremic community-acquired Streptococcus pneumoniae pneumonia. Arch Intern Med. 2001. 161:848–850.
37. Castro-Guardiola A, Viejo-Rodríguez AL, Soler-Simon S, Armengou-Arxé A, Bisbe-Company V, Peñarroja-Matutano G, et al. Efficacy and safety of oral and early-switch therapy for community-acquired pneumonia: a randomized controlled trial. Am J Med. 2001. 111:367–374.
38. Rhew DC, Riedinger MS, Sandhu M, Bowers C, Greengold N, Weingarten SR. A prospective, multicenter study of a pneumonia practice guideline. Chest. 1998. 114:115–119.
39. Halm EA, Fine MJ, Kapoor WN, Singer DE, Marrie TJ, Siu AL. Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. Arch Intern Med. 2002. 162:1278–1284.
40. Capelastegui A, España PP, Bilbao A, Martinez-Vazquez M, Gorordo I, Oribe M, et al. Pneumonia: criteria for patient instability on hospital discharge. Chest. 2008. 134:595–600.
41. Halm EA, Fine MJ, Marrie TJ, Coley CM, Kapoor WN, Obrosky DS, et al. Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines. JAMA. 1998. 279:1452–1457.
42. Jasti H, Mortensen EM, Obrosky DS, Kapoor WN, Fine MJ. Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia. Clin Infect Dis. 2008. 46:550–556.
43. El Moussaoui R, Opmeer BC, de Borgie CA, Nieuwkerk P, Bossuyt PM, Speelman P, et al. Long-term symptom recovery and health-related quality of life in patients with mild-to-moderate-severe community-acquired pneumonia. Chest. 2006. 130:1165–1172.
44. Chang J. Community acquired pneumonia. Korean J Med. 2000. 58:129–144.
45. Hyun I. Treatment of Outpatient community-acquired pneumonia. Korean J Med. 2003. 64:139–143.
46. Bruns AH, Oosterheert JJ, Hak E, Hoepelman AI. Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia. Eur Respir J. 2008. 32:726–732.
47. Siegel RE, Halpern NA, Almenoff PL, Lee A, Cashin R, Greene JG. A prospective randomized study of inpatient iv. antibiotics for community-acquired pneumonia. The optimal duration of therapy. Chest. 1996. 110:965–971.
48. Léophonte P, File T, Feldman C. Gemifloxacin once daily for 7 days compared to amoxicillin/clavulanic acid thrice daily for 10 days for the treatment of community-acquired pneumonia of suspected pneumococcal origin. Respir Med. 2004. 98:708–720.
49. Rovira E, Martínez-Moragón E, Belda A, Gonzalvo F, Ripollés F, Pascual JM. Treatment of community-acquired pneumonia in outpatients: randomized study of clarithromycin alone versus clarithromycin and cefuroxime. Respiration. 1999. 66:413–418.
50. Omidvari K, de Boisblanc BP, Karam G, Nelson S, Haponik E, Summer W. Early transition to oral antibiotic therapy for community-acquired pneumonia: duration of therapy, clinical outcomes, and cost analysis. Respir Med. 1998. 92:1032–1039.
51. O'Doherty B, Dutchman DA, Pettit R, Maroli A. Randomized, double-blind, comparative study of grepafloxacin and amoxicillin in the treatment of patients with community-acquired pneumonia. J Antimicrob Chemother. 1997. 40:Suppl A. 73–81.
52. Bruns AH, Oosterheert JJ, Prokop M, Lammers JW, Hak E, Hoepelman AI. Patterns of resolution of chest radiograph abnormalities in adults hospitalized with severe community-acquired pneumonia. Clin Infect Dis. 2007. 45:983–991.
53. Woo JH, Kang JM, Kim YS, Shin WS, Ryu JH, Choi JH, et al. A prospective multicenter study of community-acquired pneumonia in adults with emphasis on bacterial etiology. Korean J Infect Dis. 2001. 33:1–7.
54. Chung MH, Shin WS, Kim YR, Kang MW, Kim MJ, Jung HJ, et al. Etiology of community-acquired pneumonia surveyed by 7 university hospitals. Korean J Infect Dis. 1997. 29:339–359.
55. Yu CW, Park CW, Hwang BY, Song JY, Park O, Sohn JW, et al. Clinical features and prognosis of community-acquired pneumonia in the elderly patients. Korean J Infect Dis. 2000. 32:212–218.
56. Sohn JW, Park SC, Choi YH, Woo HJ, Cho YK, Lee JS, et al. Atypical pathogens as etiologic agents in hospitalized patients with community-acquired pneumonia in Korea: a prospective multi-center study. J Korean Med Sci. 2006. 21:602–607.
57. Song JH, Oh WS, Kang CI, Chung DR, Peck KR, Ko KS, et al. Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian network for surveillance of resistant pathogens. Int J Antimicrob Agents. 2008. 31:107–114.
58. Lee DD, Song EJ, Lee SM, Lee EY, Kim YS, Lee MK, et al. Frequency of legionella infection in patients with community-acquired pneumonia. Korean J Lab Med. 2005. 25:416–420.
59. Joo CH, Yoon HJ, Nam JH, Moon MS, Cho YK, Woo JH, et al. A prospective multicenter study on the etiological analysis of community-acquired pneumonia in adult patients in Korea: detection of mycoplasma pneumoniae and chlamydia pneumoniae infections. Korean J Infect Dis. 2001. 33:15–24.
60. Kim MJ, Cheong HJ, Sohn JW, Shim HS, Park DW, Park SC, et al. A prospective multicenter study of the etiological analysis in adults with community-acquired pneumonia: Legionella, Leptospira, Hantaan virus and orientia tsutsugamushi. Korean J Infect Dis. 2001. 33:24–31.
61. Song HS, Suh JH, Ahn JH, Yoon BI, Lee SJ, Lee MG, et al. The etiological role of legionella pneumophila in patients with community-acquired pneumonia in Korea. Tuberc Respir Dis. 2001. 50:409–414.
62. Lee SJ, Lee MG, Jeon MJ, Jung KS, Lee HK, Kishimoto T. Atypical pathogens in adult patients admitted with community-acquired pneumonia in Korea. Jpn J Infect Dis. 2002. 55:157–159.
63. Kim JH, Kwak YH, Na BK, Lee JY, Shin GC, Jung HS, et al. Viral etiology of community-acquired pneumonia in Korean adults. Korean J Infect Dis. 2001. 33:8–14.
64. Lew WJ, Lee EG, Bai JY, Kim HJ, Bai GH, Ahn DI, et al. An Internet-based surveillance system for tuberculosis in Korea. Int J Tuberc Lung Dis. 2006. 10:1241–1247.
65. Lee SH, Hur GY, Jung KH, Lee SY, Lee SY, Kim JH, et al. Clinical investigation of tuberculous pneumonia. Tuberc Respir Dis. 2004. 57:19–24.
66. Park SD, Chung MH, Lee HM, Kim MK, Kang JS. A Case of scrub typhus in summer presenting as atypical pneumonia. Infect Chemother. 2008. 40:241–245.
67. Kim BN, Bae LG, Kim MN, Park SJ, Woo JH, Ryu J, et al. Risk factors for penicillin resistance and mortality in Korean adults with Streptococcus pneumoniae bacteremia. Eur J Clin Microbiol Infect Dis. 2002. 21:35–42.
68. Lee NY, Song JH, Kim S, Peck KR, Ahn KM, Lee SI, et al. Carriage of antibiotic-resistant pneumococci among Asian children: a multinational surveillance by the Asian Network for Surveillance of Resistant Pathogens (ANSORP). Clin Infect Dis. 2001. 32:1463–1469.
69. Farrell DJ, Morrissey I, Bakker S, Felmingham D. Molecular characterization of macrolide resistance mechanisms among Streptococcus pneumoniae and Streptococcus pyogenes isolated from the PROTEKT 1999-2000 study. J Antimicrob Chemother. 2002. 50:Suppl S1. 39–47.
70. Schito GC, Felmingham D. Susceptibility of Streptococcus pneumoniae to penicillin, azithromycin and telithromycin (PROTEKT 1999-2003). Int J Antimicrob Agents. 2005. 26:479–485.
71. Song JH, Jung SI, Ko KS, Kim NY, Son JS, Chang HH, et al. High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study). Antimicrob Agents Chemother. 2004. 48:2101–2107.
72. Lee K, Lim CH, Cho JH, Lee WG, Uh Y, Kim HJ, et al. High prevalence of ceftazidime-resistant Klebsiella pneumoniae and increase of imipenem-resistant Pseudomonas aeruginosa and Acinetobacter spp. in Korea: a KONSAR program in 2004. Yonsei Med J. 2006. 47:634–645.
73. Shin JH, Jung HJ, Kim HR, Jeong J, Jeong SH, Kim S, et al. Prevalence, characteristics, and molecular epidemiology of macrolide and fluoroquinolone resistance in clinical isolates of Streptococcus pneumoniae at five tertiary-care hospitals in Korea. Antimicrob Agents Chemother. 2007. 51:2625–2627.
74. Kim IS, Ki CS, Kim S, Oh WS, Peck KR, Song JH, et al. Diversity of ampicillin resistance genes and antimicrobial susceptibility patterns in Haemophilus influenzae strains isolated in Korea. Antimicrob Agents Chemother. 2007. 51:453–460.
75. Chang MW, Kim KH, Park ID, Kang KH, Kong EH, Jung MH, et al. Rapid detection of Mycoplasma pneumoniae and antimicrobial susceptibilities of the M. pneumoniae isolates. J Bacteriol Virol. 2003. 33:183–191.
76. Morozumi M, Iwata S, Hasegawa K, Chiba N, Takayanagi R, Matsubara K, et al. Increased macrolide resistance of Mycoplasma pneumoniae in pediatric patients with community-acquired pneumonia. Antimicrob Agents Chemother. 2008. 52:348–350.
77. Arnold FW, Summersgill JT, Lajoie AS, Peyrani P, Marrie TJ, Rossi P, et al. A worldwide perspective of atypical pathogens in community-acquired pneumonia. Am J Respir Crit Care Med. 2007. 175:1086–1093.
78. Robenshtok E, Shefet D, Gafter-Gvili A, Paul M, Vidal L, Leibovici L. Empiric antibiotic coverage of atypical pathogens for community acquired pneumonia in hospitalized adults. Cochrane Database Syst Rev. 2008. CD004418.
79. Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005. 115:1048–1057.
80. Granizo JJ, Gimenez MJ, Barberan J, Coronel P, Gimeno M, Aguilar L. The efficacy of cefditoren pivoxil in the treatment of lower respiratory tract infections, with a focus on the per-pathogen bacteriologic response in infections caused by Streptococcus pneumoniae and Haemophilus influenzae: a pooled analysis of seven clinical trials. Clin Ther. 2006. 28:2061–2069.
81. Lee MY, Ko KS, Oh WS, Park S, Lee JY, Baek JY, et al. In vitro activity of cefditoren: antimicrobial efficacy against major respiratory pathogens from Asian countries. Int J Antimicrob Agents. 2006. 28:14–18.
82. Yi J, Lee JK, Kim EC. In vitro antimicrobial activity of cefditoren pivoxil, an oral cephalosporin, against major clinical isolates. Infect Chemother. 2003. 35:211–214.
83. Heffelfinger JD, Dowell SF, Jorgensen JH, Klugman KP, Mabry LR, Musher DM, et al. Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group. Arch Intern Med. 2000. 160:1399–1408.
84. Lautenbach E, Larosa LA, Kasbekar N, Peng HP, Maniglia RJ, Fishman NO. Fluoroquinolone utilization in the emergency departments of academic medical centers: prevalence of, and risk factors for, inappropriate use. Arch Intern Med. 2003. 163:601–605.
85. Noreddin AM, Marras TK, Sanders K, Chan CK, Hoban DJ, Zhanel GG. Pharmacodynamic target attainment analysis against Streptococcus pneumoniae using levofloxacin 500 mg, 750 mg and 1,000 mg once daily in plasma (P) and epithelial lining fluid (ELF) of hospitalized patients with community acquired pneumonia (CAP). Int J Antimicrob Agents. 2004. 24:479–484.
86. File TM Jr, Milkovich G, Tennenberg AM, Xiang JX, Khashab MM, Zadeikis N. Clinical implications of 750 mg, 5-day levofloxacin for the treatment of community-acquired pneumonia. Curr Med Res Opin. 2004. 20:1473–1481.
87. File TM Jr, Mandell LA, Tillotson G, Kostov K, Georgiev O. Gemifloxacin once daily for 5 days versus 7 days for the treatment of community-acquired pneumonia: a randomized, multicentre, double-blind study. J Antimicrob Chemother. 2007. 60:112–120.
88. Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ. Associations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with pneumonia. Arch Intern Med. 1999. 159:2562–2572.
89. Dudas V, Hopefl A, Jacobs R, Guglielmo BJ. Antimicrobial selection for hospitalized patients with presumed community-acquired pneumonia: a survey of nonteaching US community hospitals. Ann Pharmacother. 2000. 34:446–452.
90. Brown RB, Iannini P, Gross P, Kunkel M. Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database. Chest. 2003. 123:1503–1511.
91. Mufson MA, Chan G, Stanek RJ. Penicillin resistance not a factor in outcome from invasive Streptococcus pneumoniae community-acquired pneumonia in adults when appropriate empiric therapy is started. Am J Med Sci. 2007. 333:161–167.
92. Cardoso MR, Nascimento-Carvalho CM, Ferrero F, Berezin EN, Ruvinsky R, Camargos PA, et al. Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia. Arch Dis Child. 2008. 93:221–225.
93. Song JH, Jung SI, Ki HK, Shin MH, Ko KS, Son JS, et al. Clinical outcomes of pneumococcal pneumonia caused by antibiotic-resistant strains in asian countries: a study by the Asian Network for Surveillance of Resistant Pathogens. Clin Infect Dis. 2004. 38:1570–1578.
94. Hong JH, Lee HS, Jung SH, Kim GW, Eom KS, Lee JM, et al. Prevalence and clinical outcome of penicillin-resistant pneumococcal pneumonia. Tuberc Respir Dis. 2003. 54:295–303.
95. Hwangbo B, Yoon HI, Lee SM, Choi SH, Yoo CG, Lee CT, et al. Clinical characteristics of pneumococcal bacteremia in adults: the effect of penicillin resistance on the mortality of patients with pneumococcal bacteremia. Tuberc Respir Dis. 1999. 47:184–194.
96. Torres A, Garau J, Arvis P, Carlet J, Choudhri S, Kureishi A, et al. Moxifloxacin monotherapy is effective in hospitalized patients with community-acquired pneumonia: the MOTIV study--a randomized clinical trial. Clin Infect Dis. 2008. 46:1499–1509.
97. Bhavnani SM, Ambrose PG. Cost-effectiveness of oral gemifloxacin versus intravenous ceftriaxone followed by oral cefuroxime with/without a macrolide for the treatment of hospitalized patients with community-acquired pneumonia. Diagn Microbiol Infect Dis. 2008. 60:59–64.
98. Shorr AF, Khashab MM, Xiang JX, Tennenberg AM, Kahn JB. Levofloxacin 750-mg for 5 days for the treatment of hospitalized Fine Risk Class III/IV community-acquired pneumonia patients. Respir Med. 2006. 100:2129–2136.
99. Khashab MM, Xiang J, Kahn JB. Comparison of the adverse event profiles of levofloxacin 500 mg and 750 mg in clinical trials for the treatment of respiratory infections. Curr Med Res Opin. 2006. 22:1997–2006.
100. File TM. Community-acquired pneumonia. Lancet. 2003. 362:1991–2001.
101. Torres A, Serra-Batlles J, Ferrer A, Jimenez P, Celis R, Cobo E, et al. Severe community-acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis. 1991. 144:312–318.
102. Leroy O, Saux P, Bédos JP, Caulin E. Comparison of levofloxacin and cefotaxime combined with ofloxacin for ICU patients with community-acquired pneumonia who do not require vasopressors. Chest. 2005. 128:172–183.
103. Baddour LM, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, et al. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med. 2004. 170:440–444.
104. Waterer GW, Somes GW, Wunderink RG. Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Arch Intern Med. 2001. 161:1837–1842.
105. Arancibia F, Bauer TT, Ewig S, Mensa J, Gonzalez J, Niederman MS, et al. Community-acquired pneumonia due to gram-negative bacteria and pseudomonas aeruginosa: incidence, risk, and prognosis. Arch Intern Med. 2002. 162:1849–1858.
106. Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Ortqvist A, et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J. 2005. 26:1138–1180.
107. Committee for The Japanese Respiratory Society guidelines for the management of respiratory infections. Guidelines for the management of community acquired pneumonia in adults, revised edition. Respirology. 2006. 11:Suppl 3. S79–S133.
108. Craig WA. Nightingale CH, Ambrose PG, Drusano GL, Murakawa T, editors. Pharmacodynamics of antimicrobials: general concepts and applications. Antimicrobial phamacodynamics in theory and clinical practice. 2007. 2nd ed. New York: Informa healthcare;1–19.
109. Dunbar LM, Wunderink RG, Habib MP, Smith LG, Tennenberg AM, Khashab MM, et al. High-dose, short-course levofloxacin for community-acquired pneumonia: a new treatment paradigm. Clin Infect Dis. 2003. 37:752–760.
110. Rizzato G, Montemurro L, Fraioli P, Montanari G, Fanti D, Pozzoli R, et al. Efficacy of a three day course of azithromycin in moderately severe community-acquired pneumonia. Eur Respir J. 1995. 8:398–402.
111. Schönwald S, Skerk V, Petricevic I, Car V, Majerus-Misic L, Gunjaca M. Comparison of three-day and five-day courses of azithromycin in the treatment of atypical pneumonia. Eur J Clin Microbiol Infect Dis. 1991. 10:877–880.
112. Menendez R, Torres A, Zalacain R, Aspa J, Martin Villasclaras JJ, Borderias L, et al. Risk factors of treatment failure in communityacquired pneumonia: implications for disease outcome. Thorax. 2004. 59:960–965.
113. Arancibia F, Ewig S, Martinez JA, Ruiz M, Bauer T, Marcos MA, et al. Antimicrobial treatment failures in patients with community-acquired pneumonia: causes and prognostic implications. Am J Respir Crit Care Med. 2000. 162:154–160.
114. Menéndez R, Torres A, Rodríguez de Castro F, Zalacaín R, Aspa J, Martín Villasclaras JJ, et al. Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients. Clin Infect Dis. 2004. 39:1783–1790.
115. Celis R, Torres A, Gatell JM, Almela M, Rodríguez-Roisin R, Agustí-Vidal A. Nosocomial pneumonia. A multivariate analysis of risk and prognosis. Chest. 1988. 93:318–324.
116. Sanyal S, Smith PR, Saha AC, Gupta S, Berkowitz L, Homel P. Initial microbiologic studies did not affect outcome in adults hospitalized with community-acquired pneumonia. Am J Respir Crit Care Med. 1999. 160:346–348.
117. Rosón B, Carratalà J, Fernández-Sabé N, Tubau F, Manresa F, Gudiol F, et al. Causes and factors associated with early failure in hospitalized patients with community-acquired pneumonia. Arch Intern Med. 2004. 164:502–508.
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