South African guideline for the management of community-acquired pneumonia in adults.

Abstract

CAP causes considerable morbidity and mortality throughout the world (1-3). Improving the care of patients with CAP in South Africa is particularly important because of the high burden of disease and the need to improve standards of antibiotic prescribing in the face of rising AMR (4). There are a number of important international guidelines including those of the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) (5) and the British Thoracic Society (BTS) (6). However, South Africa represents a unique environment with a high prevalence of both HIV infection and AMR such that guidelines must be locally applicable. Groups interested in approaches to the management of CAP in South Africa include the South African Thoracic Society (SATS) and the Federation of Infectious Diseases Societies of Southern Africa (FIDSSA). This guideline, under the auspices of SATS and FIDSSA, represents an update of the SATS CAP Guideline published in 2007 (7). Purpose and scope The purpose of this document is to update clinicians regarding important advances and controversies in the management of patients with CAP. South Africa has a high prevalence of HIV infection, which is a risk factor for a number of pulmonary infections with overlapping presentations including tuberculosis and Pneumocystis jirovecii pneumonia (PCP). This guideline seeks to provide practical advice on the approach to all adult patients with acute community-acquired infection of the lung parenchyma. These guidelines do not apply to the much larger group of adults with non-pneumonic lower respiratory tract infections (LRTI), including acute bronchitis, acute exacerbations of chronic obstructive pulmonary disease or illnesses labelled as ‘chest infections’. Pneumonia in non-ambulatory residents of nursing homes and other long-term care facilities epidemiologically mirrors healthcare-associated pneumonia (HCAP) and should be treated according to institutional HCAP guidelines.