Management of community-acquired pneumonia in adults.

OBJECTIVE: To revise the existing South African community-acquired pneumonia guideline in the light of the following factors: * Increasing antibiotic resistance * Introduction of new antibiotics * International trends based on evidence published since the previous guideline. The main aim of the guideline is to recommend an initial choice of antibiotics in patients with community-acquired pneumonia encompassing the following subgroups: * Adults without co-morbid illness * The elderly and/or those with associated co-morbid illness, including patients with concomitant human immunodeficiency virus (HIV) infection, and * Patients with severe pneumonia. OPTIONS: Studies comparing patient outcome obtained with the various treatment regimens have been reviewed. The choice of antibiotic is based on the most commonly isolated pathogens, with cost as a consideration. OUTCOMES: The empiric antibiotic therapy covers all commonly encountered organisms in patients with community-acquired pneumonia and is likely to achieve the best prognosis. EVIDENCE: Working group of clinicians and clinical microbiologists, following detailed literature review, particularly of studies performed in South Africa. Benefits, harms and costs. The guideline pays particular attention to cost-effectiveness in South Africa and promotes rational antibiotic prescribing with the aim of limiting emergence of antibiotic resistance. RECOMMENDATIONS: These include details of likely pathogens, an appropriate diagnostic approach, indicators of severity of illness, need for hospitalisation and antibiotic treatment options. VALIDATION: The guideline was updated by a working group of the South African Thoracic Society, which included members of the Critical Care Society of Southern Africa, and the Federation of Infectious Diseases Societies of Southern Africa. Reference was made to the recently updated international guidelines from the UK, Europe, Canada and the USA. ENDORSEMENT: The guideline is endorsed by the South African Thoracic Society, the Federation of Infectious Diseases Societies of Southern Africa, and the Critical Care Society of Southern Africa.