27 Jan 2024 • The American Thoracic Society and Infectious Diseases Society of America's (ATS/IDSA) most recent guideline on treating hospitalized patients with community-acquired pneumonia (CAP) recommends combination therapy with a β-lactam plus a macrolide or monotherapy with a respiratory fluoroquinolone.

Substituting doxycycline for a macrolide also is an option in some clinical settings (e.g., prolonged PR interval). Empirical coverage for Staphylococcus aureus or Pseudomonas aeruginosa is recommended for patients with risk factors or history of these pathogens.

In a study of 23,500 patients from 19 hospitals, patients received a β-lactam plus a macrolide (40%), a β-lactam alone (39%), a respiratory fluoroquinolone (19%), or a β-lactam plus doxycycline (2%).

Outcomes were similar for all the antibiotic regimens except for a β-lactam alone. When compared with the β-lactam-plus-macrolide combination, the β-lactam-alone regimen was associated with significantly longer time to clinical stability and borderline-significant 1.5% higher in-hospital mortality.

Source: NEJM J-Watch | Read full story