Management of community-acquired pneumonia in adults: Practice Guideline from The Dutch Working Party on Antibiotic Policy and Dutch Association of Chest Physicians

Objectives This guideline is meant for the diagnosis and antibiotic treatment of adult patients without an immunocompromising condition with community-acquired pneumonia (CAP) who present at the hospital. Methods The guideline consists of ten key questions answered by available evidence collected through a Patient, Intervention, Comparison, Outcome framework. The quality of evidence per outcome variable was graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The guideline commission formulated recommendations as strong or weak based on the graded evidence. Results The guideline provides 34 recommendations. Routine sputum and blood cultures are not advised for mild to moderately severe CAP due to their low diagnostic yield. The committee recommends against procalcitonin testing for deciding whether to start or withhold antibiotics. For mild CAP (category I), amoxicillin or doxycycline is recommended. In moderately severe CAP (category II), amoxicillin or penicillin is advised. For severe CAP on non-intensive care unit wards (category III), treatment should start with a second- or third-generation cephalosporin. In intensive care unit patients (category IV), the committee recommends a combination of cephalosporins and a fluoroquinolone. A 5-day treatment duration is suggested for CAP with a good clinical response. Use of corticosteroids are recommended in specified cases of severe hypoxia or mechanical ventilation. Routine follow-up chest imaging is not advised if recovery is progressing well. Patients and their families should be informed about the expected recovery process. Conclusions Our multidisciplinary committee formulated evidence-based recommendations for the diagnosis and antibiotic treatment of CAP for adults presenting at the hospital in the Netherlands.