Optimal treatment strategies for community-acquired pneumonia: non-responders to conventional regimens.

When patients with community-acquired pneumonia (CAP) fail to respond after initiation of empirical therapy, it is necessary for the physician to consider a number of possibilities. The diagnosis should be reviewed, with consideration given to both non-infectious and infectious illnesses. If the diagnosis is correct, the failure may relate to three areas: host-related problems, including overwhelming infection and empyema, pathogen-related problems, including infection caused by an unusual or resistant pathogen, and drug-related problems, including inappropriate dose of drug, poor compliance, malabsorption, and drug interactions. A systematic therapeutic approach including a microbiological evaluation to identify the causative pathogen and its susceptibility will help to ensure that an appropriate antimicrobial agent is used. Copyright 2001 S. Karger AG, Basel