Management of community-acquired pneumonia in adults. Working groups of the South African Pulmonology Society and the Antibiotic Study Group of South Africa.

OBJECTIVE: To recommend an initial choice of antibiotic therapy in immunocompetent patients with community-acquired pneumonia encompassing the following subgroups: (i) adults < 60 years without co-morbid illness; (ii) older patients > 60 years and/or cases with associated co-morbidity; and (iii) those with severe pneumonia. OPTIONS: Few studies exist worldwide comparing patient outcome with the various treatment regimens. The choice of antibiotic is based on the most commonly isolated pathogens with cost as consideration. OUTCOMES: The empiric antibiotic therapy covers all commonly encountered organisms in patients with community-acquired pneumonia and is thus likely to be associated with the best prognosis. EVIDENCE: Working groups of clinicians, pharmacologists and medical microbiologists, following detailed literature review, particularly of studies performed in South Africa Benefits, harms, costs. The guidelines pay particular attention to cost-effectiveness in South Africa. RECOMMENDATIONS: These include details of likely pathogens, an appropriate diagnostic approach, factors suggesting need for hospitalisation and severity of illness, and treatment options. VALIDATION: Developed by working groups of the South African Pulmonology Society and the Antibiotic Study Group of South Africa. Reference was made to recent international guidelines from the UK, Canada and the USA.