Updated Acute Community-Acquired Pneumonia in Adults: Guidelines for Initial Antimicrobial Therapy Based on Local Evidence from the South American Working Group (Consensur II)

Abstract

A great variability may be noted among different countries in the selection of the primary choice in the antimicrobial agents for the treatment of community-acquired pneumonia (CAP), even for the cases considered as at a low-risk class. This fact may be due to many microbial causes of CAP and specialties involved, as well as different health-care systems effecting on the availability or cost of antibiotics. However, many countries or regions adopt some of the guidelines or design their own recommendations regardless of the local data, probably because of the scarcity of such data. This is the reason why we have developed a guideline for the initial treatment of CAP by 2002 upon the basis of several local evidences in South America (Consensur I). However, several issues deserve to be currently rediscussed as follows: i). Certain clinical scores other than the Physiological Severity Index (PSI) have become more popular in clinical practice (i.e. CURB-65, CRB-65) ii). Some pathogens have emerged in the region, such as community-acquired Staphylococcus aureus (CA-MRSA) and Legionella spp, iii). New evidences on the performance of the rapid test for the etiologic diagnosis in CAP have been reported (e.g., urinary Legionella and pneumococcus antigens), iv). New therapeutic considerations needs to be approached (i.e. dosage reformulation, duration of treatment, emergence of novel antibiotics and clinical impact of combined therapy) and finally, v). the real clinical impact of the penicillin-resistant S. pneumoniae in CAP. Like in the first version of the Consensur (Consensur I), the various current guidelines have helped to organize and stratify the present proposal, Consensur II.