Community-acquired pneumonia (CAP) is one of the most common respiratory infections, with an incidence that ranges from 8 to 50 cases per 1000 habitants per year. Obviously these figures depend on age and comorbidities. For example, patients older than 65 have incidences higher than 40 per 1000/year. With the overall increase of old patients, CAP represents one of the major problems in this population.
Mortality is still very high ranging from 4 to 20%. Patients requiring hospitalization have a high mortality (10–20%) and patients with severe CAP requiring intensive-care-unit (ICU) admission have the highest, ranging from 20 to 50 %.
Nowadays, the risk factors for mortality are very well known. Some of these factors are inherent to host comorbidities and microbial particularities. Some other factors are clearly related to antibiotic treatment; delay in administering antibiotics, inadequacy of empirical antibiotics and lack of adherence to guidelines are factors clearly associated with worse outcome, including mortality, length of stay, clinical stability and complications. All these factors are amenable to medical intervention.
This book is mainly devoted to antibiotic treatment of CAP. As a first step the epidemiology and microbial aetiology of ambulatory and hospitalized CAP is reviewed by experts. This is necessary to understand the current antibiotic recommendations. The reader will find a review in depth of the three major classes of antibiotics used for the treatment of CAP: ?-lactams, macrolides and quinolones. All of them have advantages and disadvantages that the experts have placed in perspective. Guideline recommendations are also assessed and this is crucial since guidelines are increasingly a requirement of health authorities for a good quality of care.
Despite adequate antibiotic treatment, 10% of hospitalized CAP patients present a lack of response to antibiotics. Needless to say that this population carries the highest mortality. This concept of lack of response is covered by experts that have investigated this particular problem. This population could benefit from adjunctive therapies, some of them still under investigation and also reviewed in this monograph.
The editors hope that this book will be of help to all physicians dealing with the frequent clinical problem of CAP and very specifically in prescribing antibiotics correctly and adequately. The editors would like to express their enormous gratitude to all the authors who contributed to this book.
Antoni Torres and Rosario Men´endez
December, 2007
Contents
1 Epidemiology of Community-Acquired Pneumonia Outside Hospital
2 Epidemiology of Adult Hospitalized Community-Acquired Pneumonia
3 Microbial Aetiology and Antibiotic Resistances in Community-Acquired Pneumonia
4 Microbiological Diagnosis of Community-Acquired Pneumonia
5 Empirical Treatment of Community-Acquired Pneumonia: Current Guidelines
6 Pathogen Directed Antimicrobial Treatment of Pneumonia
7 General Pharmacological Considerations in Antibiotic Treatment of Community-Acquired Pneumonia
8 Beta-Lactams in the Therapy of Community-Acquired Pneumonia
9 Macrolides and Ketolides
10 Role of Fluoroquinolones in the Treatment of Community-Acquired Pneumonia
11 Non-Responding Pneumonia
12 Influenza and Pneumococcal Vaccination for Prevention of Community-Acquired Pneumonia in Immunocompetent Adults
13 Adjunctive Therapy in Community-Acquired Pneumonia
Index
Mortality is still very high ranging from 4 to 20%. Patients requiring hospitalization have a high mortality (10–20%) and patients with severe CAP requiring intensive-care-unit (ICU) admission have the highest, ranging from 20 to 50 %.
Nowadays, the risk factors for mortality are very well known. Some of these factors are inherent to host comorbidities and microbial particularities. Some other factors are clearly related to antibiotic treatment; delay in administering antibiotics, inadequacy of empirical antibiotics and lack of adherence to guidelines are factors clearly associated with worse outcome, including mortality, length of stay, clinical stability and complications. All these factors are amenable to medical intervention.
This book is mainly devoted to antibiotic treatment of CAP. As a first step the epidemiology and microbial aetiology of ambulatory and hospitalized CAP is reviewed by experts. This is necessary to understand the current antibiotic recommendations. The reader will find a review in depth of the three major classes of antibiotics used for the treatment of CAP: ?-lactams, macrolides and quinolones. All of them have advantages and disadvantages that the experts have placed in perspective. Guideline recommendations are also assessed and this is crucial since guidelines are increasingly a requirement of health authorities for a good quality of care.
Despite adequate antibiotic treatment, 10% of hospitalized CAP patients present a lack of response to antibiotics. Needless to say that this population carries the highest mortality. This concept of lack of response is covered by experts that have investigated this particular problem. This population could benefit from adjunctive therapies, some of them still under investigation and also reviewed in this monograph.
The editors hope that this book will be of help to all physicians dealing with the frequent clinical problem of CAP and very specifically in prescribing antibiotics correctly and adequately. The editors would like to express their enormous gratitude to all the authors who contributed to this book.
Antoni Torres and Rosario Men´endez
December, 2007
1 Epidemiology of Community-Acquired Pneumonia Outside Hospital
2 Epidemiology of Adult Hospitalized Community-Acquired Pneumonia
3 Microbial Aetiology and Antibiotic Resistances in Community-Acquired Pneumonia
4 Microbiological Diagnosis of Community-Acquired Pneumonia
5 Empirical Treatment of Community-Acquired Pneumonia: Current Guidelines
6 Pathogen Directed Antimicrobial Treatment of Pneumonia
7 General Pharmacological Considerations in Antibiotic Treatment of Community-Acquired Pneumonia
8 Beta-Lactams in the Therapy of Community-Acquired Pneumonia
9 Macrolides and Ketolides
10 Role of Fluoroquinolones in the Treatment of Community-Acquired Pneumonia
11 Non-Responding Pneumonia
12 Influenza and Pneumococcal Vaccination for Prevention of Community-Acquired Pneumonia in Immunocompetent Adults
13 Adjunctive Therapy in Community-Acquired Pneumonia
Index
Book Details
- Hardcover: 286 pages
- Publisher: Wiley; 1 edition (September 23, 2008)
- Language: English
- ISBN-10: 0470058099
- ISBN-13: 978-0470058091
- Product Dimensions: 9.8 x 6.8 x 0.8 inches