Guidelines of the Paul-Ehrlich-Society of Chemotherapy, the German Respiratory Diseases Society, the German Infectious Diseases Society and of the Competence Network CAPNETZ for the Management of Lower Respiratory Tract Infections and Community-acquired Pneumonia

Summary Update 2009

This summary of the update of the guidelines for the management of lower respiratory tract infections and community-acquired pneumonia (CAP) provides an overview on the structure and key points provided in this document. It is based on the structure of the Oxford Centre of Evidence Based Medicine.

The update refers to important new insights from studies published by the CAPNETZ and the Bundesgeschäftsstelle für Qualitätssicherung (BQS). Essential new statements as compared to the original 2005 version include the following: 1) treatment of patients with acute exazerbation of COPD (restrictive indications for antimicrobial treatment); 2) preference for the CRB-65 score as tool for the validation of clinical assessment of pneumonia severity; 3) treatment of patients with mild CAP (oral cephalosporins no longer recommended); 4) treatment of patients with moderate CAP (ertapenem as new option in selected cases); 5) treatment of patients with severe CAP (antipseudomonal treatment only rarely indicated; reintroduction of aminoglycosides as agent in combination treatment); 6) reduction of treatment duration; 7) new focus on palliative treatment of patients with CAP.

Selected References

• 1 Von Baum H, Ewig S, Marre R. et al . Community-acquired Legionella pneumonia: new insights from the German competence network for community acquired pneumonia.  Clin Infect Dis. 2008;  46 1356-1364
• 2 Gonzales R, Steiner J F, Lum A, Barrett Jr P H. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults.  JAMA. 1999;  281 1512-1519
• 3 Stockley R A, O’Brien C, Pye A, Hill S L. Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD.  Chest. 2000;  117 1638-1645
• 4 Lim W S, van der Eerden M M, Laing R. et al . Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.  Thorax. 2003;  58 377-382
• 5 Bauer T T, Ewig S, Marre R. et al . CRB-65 predicts death from community-acquired pneumonia.  J Intern Med. 2006;  260 93-101
• 6 Vetter N, Cambronero-Hernandez E, Rohlf J. et al . A prospective, randomized, double-blind multicenter comparison of parenteral ertapenem and ceftriaxone for the treatment of hospitalized adults with community-acquired pneumonia.  Clin Ther. 2002;  24 1770-1785
• 7 Yakovlev S V, Stratchounski L S, Woods G L. et al . Ertapenem versus cefepime for initial empirical treatment of pneumonia acquired in skilled-care facilities or in hospitals outside the intensive care unit.  Eur J Clin Microbiol Infect Dis. 2006;  25 633-641
• 8 Rodriguez A, Mendia A, Sirvent J M. et al . Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock.  Crit Care Med. 2007;  35 1493-1498
• 9 Arancibia F, Ewig S, Martinez J A. et al . Antimicrobial treatment failures in patients with community-acquired pneumonia: Causes and prognostic implications.  Am J Respir Crit Care Med. 2000;  162 154-160
• 10 Ewig S. für die BQS-Arbeitsgruppe Pneumonie . Therapiebegrenzung: Herausforderung für die ärztliche Urteilskraft.  Dt Ärztebl. 2008;  105 A878-A879