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College of Pharmacy

HelixTalk Episode #106 - It’s Finally Here! The 2019 IDSA CAP Guidelines

Date posted: December 24, 2019, 6:00 am

In this episode, we discuss the important updates in the 2019 IDSA Community Acquired Pneumonia (CAP) guidelines with Dr. Christie Bertram, PharmD, an Infectious Diseases Clinical Pharmacist and Assistant Professor at Rosalind Franklin University’s College of Pharmacy.

Key Concepts

  1. In patients with CAP, respiratory and blood cultures should only be collected in hospitalized patients with severe CAP (based on specific criteria) or those with MRSA or Pseudomonas risk factors.
  2. The preferred outpatient CAP therapy in patients without comorbidities is amoxicillin or doxycycline.  For those with comorbidities, a B-lactam (amoxicillin/clavulanate, cefpodoxime, or cefdinir) with atypical coverage (macrolide or doxycycline) or a respiratory fluoroquinolone (levofloxacin or moxifloxacin) is recommended.
  3. Hospitalized CAP patients should have MRSA and Pseudomonas coverage only if they have a history of respiratory cultures with one of these organisms or if they were hospitalized within the past 90 days and received IV antibiotics.  Patients with “severe” CAP do not necessarily warrant anti-MRSA/anti-Pseudomonas coverage.
  4. Patients with aspiration pneumonia do not need anaerobic coverage unless a lung abscess or empyema is suspected.

References

  • Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. Available at https://www.atsjournals.org/doi/full/10.1164/rccm.201908-1581ST.