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Guidelines for Empiric Antimicrobial Prescribing in Community-Acquired Pneumonia*

Thomas M. File, Jr, MD, FCCP; Javier Garau, MD; Francesco Blasi, MD, PhD; Christian Chidiac, MD; Keith Klugman, MD; Hartmut Lode, MD; John R. Lonks, MD; Lionel Mandell, MD; Julio Ramirez, MD; Victor Yu, MD
Author and Funding Information

*From the Northeastern Ohio Universities College of Medicine, Rootstown, OH (Dr. File); Hospital Mutua de Terrassa (Dr. Garau), University of Barcelona, Spain; Università di Milano (Dr. Blasi), Milan, Italy; Hôpital de la Croix Rousse (Dr. Chidiac), Lyon, France; Rollins School of Public Health (Dr. Klugman), Emory University, Atlanta, GA; Zentralklinik Emil von Behring (Dr. Lode), Heckeshorn, Berlin; The Miriam Hospital, Brown Medical School (Dr. Lonks), Providence, Rhode Island,; McMaster University (Dr. Mandell), Hamilton, ON, Canada; University of Louisville (Dr. Ramirez), Veterans Affairs Medical Center, Louisville, KY; and Veterans Affairs Medical Center (Dr. Yu), Pittsburgh, PA.

Correspondence to: Thomas M. File, Jr, MD, FCCP, 75 Arch St, Suite 105, Akron, OH 44304; e-mail: filet@summa-health.org



Chest. 2004;125(5):1888-1901. doi:10.1378/chest.125.5.1888
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Empiric antimicrobial prescribing for community-acquired pneumonia remains a challenge, despite the availability of treatment guidelines. A number of key differences exist between North American and European guidelines, mainly in the outpatient setting. The North American approach is to use initial antimicrobial therapy, which provides coverage for Streptococcus pneumoniae plus atypical pathogens. Europeans tend to focus on providing pneumococcal coverage with less emphasis on covering for an atypical pathogen. Ambulatory patients without comorbidity are more likely to receive macrolide therapy in North America, whereas in Europe these patients would probably receive a β-lactam agent. Major issues that are fundamental to this difference include the importance of providing therapy for atypical pathogens and the clinical significance of macrolide-resistant S pneumoniae. Prospective data are required to evaluate which of these two approaches offers clinical superiority.


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