Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, 240 East Huron Street, McGaw M-336, Chicago, IL 60611, USA.
Clin Chest Med. 2018 Dec;39(4):723-731. doi: 10.1016/j.ccm.2018.07.006.
Few guidelines have greater acceptance than that for management of community-acquired pneumonia (CAP). Despite this, areas remain controversial, and new challenges continue to emerge. Current guidelines differ from those of northern European countries predominantly in need for macrolide combination with β-lactams for hospitalized, non-intensive care unit patients. A preponderance of evidence favors combination therapy. Challenges for current and future CAP guidelines include new antibiotic classes, emergence of viruses as major causes for CAP, new diagnostic modalities, alternative risk stratification for pathogens resistant to usual CAP antibiotics, and evidence-based management of severe CAP, including immunomodulatory therapy such as corticosteroids.
很少有指南能像社区获得性肺炎 (CAP) 管理指南那样被广泛接受。尽管如此,仍有一些领域存在争议,并且新的挑战不断出现。当前的指南与北欧国家的指南主要不同之处在于,需要将大环内酯类药物与β-内酰胺类药物联合用于住院、非重症监护病房患者。大量证据支持联合治疗。当前和未来 CAP 指南面临的挑战包括新的抗生素类别、病毒成为 CAP 的主要原因、新的诊断方式、对通常用于 CAP 抗生素的病原体具有耐药性的替代风险分层,以及严重 CAP 的基于证据的管理,包括免疫调节治疗如皮质类固醇。