Atypical pathogens and challenges in community-acquired pneumonia

• Published in: American family physician Vol. 69; no. 7; pp. 1699 - 1706
• Main Authors: Thibodeau, Kristopher P, Viera, Anthony J
• Format: Journal Article
• Language: English
• Published: United States American Academy of Family Physicians 01.04.2004
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bioterrorism; Child; Community-Acquired Infections - diagnosis; Community-Acquired Infections - drug therapy; Community-Acquired Infections - microbiology; Disease control; Female; Humans; Male; Medical treatment; Middle Aged; Pathogens; Pneumonia; Pneumonia - diagnosis; Pneumonia - drug therapy; Pneumonia - microbiology; Predictive Value of Tests; Risk Factors
• ISSN: 0002-838X

Atypical organisms such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila are implicated in up to 40 percent of cases of community-acquired pneumonia. Antibiotic treatment is empiric and includes coverage for both typical and atypical organisms. Doxycycline, a fluoroquinolone with enhanced activity against Streptococcus pneumoniae, or a macrolide is appropriate for outpatient treatment of immunocompetent adult patients. Hospitalized adults should be treated with cefotaxime or ceftriaxone plus a macrolide, or with a fluoroquinolone alone. The same agents can be used in adult patients in intensive care units, although fluoroquinolone monotherapy is not recommended; ampicillin-sulbactam or piperacillin-tazobactam can be used instead of cefotaxime or ceftriaxone. Outpatient treatment of children two months to five years of age consists of high-dose amoxicillin given for seven to 10 days. A single dose of ceftriaxone can be used in infants when the first dose of antibiotic is likely to be delayed or not absorbed. Older children can be treated with a macrolide. Hospitalized children should be treated with a macrolide plus a beta-lactam inhibitor. In a bioterrorist attack, pulmonary illness may result from the organisms that cause anthrax, plague, or tularemia. Sudden acute respiratory syndrome begins with a flu-like illness, followed two to seven days later by cough, dyspnea and, in some instances, acute respiratory distress.