Community-Acquired Pneumonia: Strategies for Management

288 Pages·2008·1.29 MB·English

by  Antoni Torres

Community-Acquired
Pneumonia

Community-Acquired
Pneumonia
Strategies for Management
Edited by
Antoni Torres
Hospital Cl´ınic de Barcelona, Spain
Rosario Mene´ndez
Hospital Universitario La Fe, Valencia, Spain
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LibraryofCongressCataloging-in-PublicationData
Communityacquiredpneumonia:strategiesformanagement/editedbyAntoniTorresandRosarioMene´ndez.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-470-05809-1
1. Community-acquiredpneumonia. I. TorresMart´ı,A.(Antoni)II.Mene´ndez,Rosario.
[DNLM:1. Pneumonia–diagnosis.2. Pneumonia–therapy.3. Community-AcquiredInfections. WC202C73482008]
RC771.C6742008
616.2(cid:1)41–dc22
2008012124
BritishLibraryCataloguinginPublicationData
AcataloguerecordforthisbookisavailablefromtheBritishLibrary
ISBN978-0-470-05809-1
Typesetin10.5/12.5TimesbyLaserwordsPrivateLimited,Chennai,India
PrintedandboundinSingaporebyMarkonoLtd
Contents
Preface vii
List of Contributors ix
1 Epidemiology of Community-Acquired Pneumonia Outside
Hospital 1
Theo JM Verheij
2 Epidemiology of Adult Hospitalized Community-Acquired
Pneumonia 5
Mark Woodhead
3 Microbial Aetiology and Antibiotic Resistances in
Community-Acquired Pneumonia 21
Ge´rard Huchon
4 Microbiological Diagnosis of Community-Acquired Pneumonia 43
Margareta Ieven
5 Empirical Treatment of Community-Acquired Pneumonia:
Current Guidelines 63
Javier Aspa, Olga Rajas, Felipe Rodr´ıguez de Castro, Jose´ Blanquer
and Antoni Torres
6 Pathogen Directed Antimicrobial Treatment of Pneumonia 101
Santiago Ewig and So¨ren Gatermann
7 General Pharmacological Considerations in Antibiotic Treatment
of Community-Acquired Pneumonia 127
Francesco Blasi, Mario Cazzola and Paolo Tarsia
8 β-Lactams in the Therapy of Community-Acquired Pneumonia 153
Michael S. Niederman
vi CONTENTS
9 Macrolides and Ketolides 171
Javier Garau
10 Role of Fluoroquinolones in the Treatment of
Community-Acquired Pneumonia 193
Tobias Welte
11 Non-Responding Pneumonia 213
Rosario Mene´ndez
12 Influenza and Pneumococcal Vaccination for Prevention of
Community-Acquired Pneumonia in Immunocompetent Adults 229
A˚ke O¨rtqvist
13 Adjunctive Therapy in Community-Acquired Pneumonia 245
Anna P. Lam and Richard G. Wunderink
Index 263
Preface
Community-acquired pneumonia (CAP) is one of the most common respiratory
infections, with an incidence that ranges from 8 to 50 cases per 1000 habitants
per year. Obviously these figures depend on age and comorbidities. For example,
patients older than 65 have incidences higher than 40 per 1000/year. With the
overall increase of old patients, CAP represents one of the major problems in this
population.
Mortality is still very high ranging from 4 to 20%. Patients requiring hospital-
ization have a high mortality (10–20%) and patients with severe CAP requiring
intensive-care-unit (ICU) admission have the highest, ranging from 20 to 50%.
Nowadays, the risk factors for mortality are very well known. Some of these
factors are inherent to host comorbidities and microbial particularities. Some other
factorsareclearlyrelatedtoantibiotictreatment;delayinadministeringantibiotics,
inadequacy of empirical antibiotics and lack of adherence to guidelines are factors
clearly associated with worse outcome, including mortality, length of stay, clinical
stabilityand complications. All these factors are amenable to medical intervention.
This book is mainly devoted to antibiotic treatment of CAP. As a first step
the epidemiology and microbial aetiology of ambulatory and hospitalized CAP is
reviewed by experts. This is necessary to understand the current antibiotic recom-
mendations. The reader will find a review in depth of the three major classes of
antibiotics used for the treatment of CAP: β-lactams, macrolides and quinolones.
All of them have advantages and disadvantages that the experts have placed in
perspective. Guideline recommendations are also assessed and this is crucial since
guidelines are increasingly a requirement of health authorities for a good quality
of care.
Despiteadequateantibiotictreatment,10%ofhospitalizedCAPpatientspresent
a lack of response to antibiotics. Needless to say that this population carries the
highest mortality. This concept of lack of response is covered by experts that have
investigated this particular problem. This population could benefit from adjunc-
tive therapies, some of them still under investigation and also reviewed in this
monograph.