Duration of Antimicrobial Therapy in Community Acquired Pneumonia: Less Is More

Community acquired pneumonia (CAP) represents the most common cause of infection-related morbidity and mortality worldwide. Appropriate treatment of CAP is challenging and sometimes limited by the availability to obtain rapid and timely identification of the etiologic agent in order to initiate or d...

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Bibliographic Details
Published in:TheScientificWorld 2014-01, Vol.2014 (2014), p.1-8
Main Authors: Nunnari, Giuseppe, Abbo, Lilian, Cacopardo, Bruno, Pinzone, Marilia Rita
Format: Article
Language:English
Subjects:
Algorithms
Anti-Bacterial Agents - administration & dosage
Anti-infective agents
Antibiotics
Antimicrobial agents
Bacterial pneumonia
Biomarkers - metabolism
Calcitonin - metabolism
Calcitonin Gene-Related Peptide
Clinical trials
Clinical Trials as Topic
Community-Acquired Infections - drug therapy
Dosage and administration
Drug Administration Schedule
Drug resistance
Drug therapy
Humans
Mortality
Pneumonia
Pneumonia - drug therapy
Protein Precursors - metabolism
Review
Streptococcus infections
Studies
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Summary:Community acquired pneumonia (CAP) represents the most common cause of infection-related morbidity and mortality worldwide. Appropriate treatment of CAP is challenging and sometimes limited by the availability to obtain rapid and timely identification of the etiologic agent in order to initiate or deescalate the correct antimicrobial therapy. As a consequence, prescribers frequently select empiric antimicrobial therapy using clinical judgment, local patterns of antimicrobial resistance, and, sometimes, individual patient expectations. These issues may contribute to prolonged courses of inappropriate therapy. In this review, we discuss the evidence and recommendations from international guidelines for the management of CAP and the clinical trials that specifically addressed duration of antimicrobial therapy for CAP in adults. In randomized controlled trials comparing the clinical efficacy of a short-course antimicrobial regimen versus an extended-course regimen, no differences in terms of clinical success, bacterial eradication, adverse events, and mortality were observed. The use of biomarkers, such as procalcitonin, to guide the initiation and duration of antimicrobial therapy may reduce total antibiotic exposure and treatment duration, healthcare costs, and the risk of developing antimicrobial resistance. In clinical practice, antimicrobial stewardship interventions may improve the management of CAP and may help in reducing treatment duration. Sometimes “less is more” in CAP.
ISSN:2356-6140
1537-744X
1537-744X
DOI:10.1155/2014/759138