Skip to main content
SpringerLink
Log in

Guidelines for Community-Acquired Pneumonia Within Disease Management Programs

A Practical Approach to Antibacterial Selection and Guideline Implementation

  • Review Article
  • Published:
Disease Management & Health Outcomes

Abstract

Several national and international organizations have developed and published guidelines for the treatment of patients with community-acquired pneumonia (CAP). Guidelines from Europe, the US, Canada and Latin America classify patients in different groups based on the severity of pneumonia, site of care and presence of risk factors for resistant organisms. The initial antibacterial therapy is designed to cover only the likely organisms able to infect a particular group of patients. An evaluation of current guidelines indicates that there are significant similarities in regard to classification of patients and initial antibacterial therapy. One objective of this review is to present the clinician with a practical approach to antibacterial selection based on current published guidelines for CAP.

Although most of the care recommended in guidelines is evidence-based and associated with better clinical outcomes and/or decreased healthcare cost, there is still a significant gap between recommended care and actual care of patients with CAP. Dissemination of guidelines at the local level has proved to have a minimal effect in changing local practices. To bring the local care of patients with CAP closer to the care recommended in guidelines, it is necessary to have an appropriate plan for guideline implementation. This review provides the clinician and other healthcare decision-makers with a methodology for implementation of national guidelines at the local hospital level.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Huchon G, Woodhead M, Gialdroni-Grassi G, et al. Guidelines for the management of adult community-acquired lower respiratory tract infections. European Respiratory Society. Eur Respir J 1998; 11: 986–91.

    Article  Google Scholar 

  2. Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia. American Thoracic Society. Am J Respir Crit Care Med 2001; 163: 1730–54.

    CAS  Google Scholar 

  3. Bartlett JG, Dowell SF, Mandell LA, et al. Practice guidelines for the management of community-acquired pneumonia in adults: Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2000; 31: 347–82.

    Article  PubMed  CAS  Google Scholar 

  4. Heffelfinger JD, Dowell SF, Jorgensen JH, et al. Management of communityacquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group. Arch Intern Med 2000 May 22; 160 (10): 1399–408.

    Article  PubMed  CAS  Google Scholar 

  5. Mandell LA, Marrie TJ, Grossman RF, et al. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. The Canadian Community-Acquired Pneumonia Working Group. Clin Infect Dis 2000 Aug; 31 (2): 383–421.

    CAS  Google Scholar 

  6. Luna CM, Ramirez JA, Lopez H, et al. Recomendaciones de la Asociacion Latinoamericana del Torax sobre la neumonia adquirida en la comunidad. Arch Bronconeumol 2001; 37: 340–8.

    PubMed  CAS  Google Scholar 

  7. Macfarlane J, and the Pneumonia Guidelines Committee of the British Thoracic Society Group. BTS Guidelines for the management of community acquired pneumonia in adults. Thorax 2001 Dec; 56 Suppl. IV: iv1-iv64.

  8. Meehan TP, Fine MJ, Krumholz HM, et al. Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA 1997 Dec 17; 278 (23): 2080–4.

    Article  PubMed  CAS  Google Scholar 

  9. Feagan BG, Marrie TJ, Lau CY, et al. Treatment and outcomes of communityacquired pneumonia at Canadian hospitals. CMAJ 2000 May 16; 162 (10): 1415–20.

    PubMed  CAS  Google Scholar 

  10. Jencks SF, Cuerdon T, Burwen DR, et al. Quality of medical care delivered to Medicare beneficiaries: a profile at state and national levels. JAMA 2000 Oct 4; 284 (13): 1670–6.

    Article  PubMed  CAS  Google Scholar 

  11. Plouffe JF. Legionnaires’ disease. In: Marrie TJ, editor. Community-acquired pneumonia. New York (NY): Kluwer Academic/Plenum Publishers, 2001: 511–30.

    Google Scholar 

  12. File Jr TM, Tan JS. Mycoplasma pneumoniae pneumonia. In: Marrie TJ, editor. Community-acquired pneumonia. New York (NY): Kluwer Academic/Plenum Publishers, 2001:487–500.

    Google Scholar 

  13. Ramirez JA, Summersgill JT. Community-acquired pneumonia due to Chlamydia pneumoniae. In: Marrie TJ, editor. Community-acquired pneumonia. New York (NY): Kluwer Academic/Plenum Publishers, 2001: 501–9.

    Google Scholar 

  14. Erwig S, Ruiz M, Torres A, et al. Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae. Am J Respir Crit Care Med 1999; 159: 1835–42.

    Google Scholar 

  15. Clavo-Sánchez AJ, Girón-González JA, López-Prieto D, et al. Multivariate analysis of risk factors for infection due to penicillin-resistant and multidrug-resistant Streptococcus pneumoniae: a multicenter study. Clin Infect Dis 1997; 24: 1052–9.

    Article  PubMed  Google Scholar 

  16. Campbell Jr GD, Sliberman R. Drug-resistant Streptococcus pneumoniae. Clin Infect Dis 1998; 26: 1188–95.

    Article  PubMed  Google Scholar 

  17. Nava JM, Bella F, Garau J, et al. Predictive factors for invasive disease due to penicillin-resistant Streptococcus pneumoniae: a population-based study. Clin Infect Dis 1994; 19: 884–90.

    Article  PubMed  CAS  Google Scholar 

  18. Ruiz M, Ewig S, Marcos MA, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med 1999; 160: 397–405.

    PubMed  CAS  Google Scholar 

  19. Riquelme R, Torres A, el-Ebiary M, et al. Community-acquired pneumonia in the elderly: clinical and nutritional aspects. Am J Respir Crit Care Med 1997; 156: 1908–14.

    PubMed  CAS  Google Scholar 

  20. Rello J, Rodriquez R, Jubert P, et al. Severe community-acquired pneumonia in the elderly: epidemiology and prognosis. Clin Infect Dis 1996; 23: 723–8.

    Article  PubMed  CAS  Google Scholar 

  21. Niederman MS. Pathogenesis of airway colonization: lessons learned from studies of bacterial adherence. Eur Respir J 1994; 7: 1737–40.

    Article  PubMed  CAS  Google Scholar 

  22. Torres A, Serra-Batlles J, Ferer A, et al. Severe community-acquired pneumonia: epidemiology and prognostic factors. Am Rev Respir Dis 1991; 144: 312–8.

    Article  PubMed  CAS  Google Scholar 

  23. Ruiz M, Eqig S, Torres A, et al. Severe community-acquired pneumonia: risk factors and follow-up epidemiology. Am J Respir Crit Care Med 1999; 160: 923–9.

    PubMed  CAS  Google Scholar 

  24. El-Solh AA, Sikka P, Ramadan F, et al. Etiology of severe pneumonia in the very elderly. Am J Respir Crit Care Med 2001; 163: 645–51.

    PubMed  CAS  Google Scholar 

  25. Ramirez JA. Switch therapy in adult patients with pneumonia. Clin Pulm Med 1995; 2 (6): 327–33.

    Article  Google Scholar 

  26. Ramirez JA, Vargas S, Ritter GW, et al. Early switch from intravenous to oral antibiotics and early hospital discharge: a prospective observational study of 200 consecutive patients with community-acquired pneumonia. Arch Intern Med 1999; 159: 2449–54.

    Article  PubMed  CAS  Google Scholar 

  27. Ramirez JA, Srinath L, Ahkee S, et al. Early switch from intravenous to oral cephalosporins in the treatment of hospitalized patients with community-acquired pneumonia. Arch Intern Med 1995; 155: 1273–6.

    Article  PubMed  CAS  Google Scholar 

  28. Ramirez JA, Bordon J. Early switch from intravenous to oral antibiotics in hospitalized patients with bacteremic streptococcus pneumoniae communityacquired pneumonia. Arch Intern Med 2001; 161: 848–50.

    Article  PubMed  CAS  Google Scholar 

  29. Raskin D. The medical staff’s role in performance improvement. In: Fager S, Editor. Medical staff performance improvement. 3rd ed. Illinois: Joint Commission on Accreditation of Healthcare Organizations, 2001: 1–32.

    Google Scholar 

  30. Raskin D. The medical staff’s role in preventing sentinel events. In: Fager S, editor. Medical staff performance improvement. 3rd ed. Illinois: Joint Commission on Accreditation of Healthcare Organizations, 2001: 45–59.

    Google Scholar 

  31. Implementation techniques and strategies. In: Joint Commission on Accreditation of Healthcare Organizations, editor. Selecting and implementing clinical practice guidelines in hospitals. Illinois: Joint Commission on Accreditation of Healthcare Organizations, 2000: 41–70.

  32. Berwick DM, Nolan TW. Physicians as leaders in improving health care: a new series in Annals of Internal Medicine. Ann Intern Med 1998; 128 (4): 289–92.

    PubMed  CAS  Google Scholar 

  33. Shekelle PG, MacLean CH, Morton SC, et al. Assessing care of vulnerable elders: methods for developing quality indicators. Ann Intern Med 2001; 135: 647–52.

    PubMed  CAS  Google Scholar 

  34. Joint Commission on Accreditation of Healthcare Organizations. Overview of the CAP Core Measure Set [online]. Available from URL: http://www.jcaho.org/pms/core+measures/CAP_verview.htm [Accessed 2002 Mar 22].

  35. Rhew DC. Quality indicators for the management of pneumonia in vulnerable elders. Ann Inter Med 2001; 135: 736–43.

    CAS  Google Scholar 

  36. Ramirez JA, Community Acquired Pneumonia Organization. An international observational study to evaluate current management of hospitalized patients with community-acquired pneumonia [online]. Available from URL: http://www.caposite.com/cap/mainSite/index.html [Accessed 2002 Oct 18].

  37. Bero LA, Grilli R, Grimshaw JM, et al., Cochrane Effective Practice and Organization of Care Review Group. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ 1998; 317: 465–8.

    Article  PubMed  CAS  Google Scholar 

  38. Grimshaw J, Freemantle N, Wallace S, et al. Developing and implementing clinical practice guidelines. Qual Health Care 1995; 5: 55–64.

    Google Scholar 

  39. Burke JD, Ahkee S, Ritter GW, et al. Development of an interdisciplinary antimicrobial team: elements for success. Hosp Pharm 1996; 3 (4): 361–6.

    Google Scholar 

  40. Kiefe CI, Allison JJ, Williams OD, et al. Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial. JAMA 2001 Jun 13; 285 (22): 2871–9.

    Article  PubMed  CAS  Google Scholar 

  41. Grol R. Beliefs and evidence in changing clinical practice. BMJ 1997 Aug 16; 315: 418–21.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. The author is one of the investigators in the Community-Acquired Pneumonia Organization (CAPO) International cohort study. The development of the study website http://www.caposite.com was funded in part by grants from the following pharmaceutical companies: Abbott, Aventis, Bayer, GlaxoSmithKline, Ortho-McNeil, and Pfizer.

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, KY, 40292, USA

    Julio A. Ramirez (Professor)

Authors
  1. Julio A. Ramirez
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ramirez, J.A. Guidelines for Community-Acquired Pneumonia Within Disease Management Programs. Dis-Manage-Health-Outcomes 11, 33–43 (2003). https://doi.org/10.2165/00115677-200311010-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200311010-00005

Keywords

Search

Navigation