Lionel A. Mandell

priate starting point for consultation by specialists. Substantial overlap exists among the patients whom these guidelines address and those discussed in the recently published guidelines for health care-associated pneumonia (HCAP). Pneumonia in nonambulatory residents of nursing homes and other long-term care facilities epidemiologically mirrors hospital-acquired pneumonia and should be treated according to the HCAP guidelines. However, certain other patients whose conditions are included in the designation of HCAP are better served by management in accordance with CAP guidelines with concern for specific pathogens.

John G. Bartlett,1 Scott F Dowell,2 Lionel A. Mandell,6 Thomas M. File, Jr.,3 Daniel M. Musher,4 and Michael J. Fine5 'Johns Hopkins University School of Medicine, Baltimore, Maryland, 2Centers for Disease Control and Prevention, Atlanta, Georgia, 3Northeastern Ohio Universities College of Medicine, Cleveland, Ohio, 4Baylor College of Medicine and Veterans Affairs Medical Center, Houston, Texas, and 5University of Pittsburgh, Pennsylvania, USA; and 6McMaster University, Toronto, Canada

"Medical Section pf the American Lung Association: Guidelines for the Initial Management of Adults with Community-acquired Pneumonia: Diagnosis, Assessment of Severity, and Initial Antimicrobial Therapy." American Review of Respiratory Disease, 148(5), pp. 1418–1426

Recent antibiotic therapy b A respiratory fluoroquinolone c alone, an advanced macrolide d plus high-dose amoxicillin, e or an advanced macrolide plus high-dose amoxicillin-clavulanate f Comorbidities (COPD, diabetes, renal or congestive heart failure, or malignancy) No recent antibiotic therapy An advanced macrolide d or a respiratory fluoroquinolone Recent antibiotic therapy A respiratory fluoroquinolone c alone or an advanced macrolide plus a b-lactam g Suspected aspiration with infection Amoxicillin-clavulanate or clindamycin Influenza with bacterial superinfection A b-lactam g or a respiratory fluoroquinolone Inpatient Medical ward No recent antibiotic therapy A respiratory fluoroquinolone alone or an advanced macrolide plus a b-lactam h Recent antibiotic therapy An advanced macrolide plus a b-lactam or a respiratory fluoroquinolone alone (regimen selected will depend on nature of recent antibiotic therapy) ICU Pseudomonas infection is not an issue A b-lactam h plus either an advanced macrolide or a respiratory fluoroquinolone Pseudomonas infection is not an issue but patient has a b-lactam allergy A respiratory fluoroquinolone, with or without clindamycin Pseudomonas infection is an issue i Either (1) an antipseudomonal agent j plus ciprofloxacin, or (2) an antipseudomonal agent plus an aminoglycoside k plus a respiratory fluoroquinolone or a macrolide Pseudomonas infection is an issue but the patient has a b-lactam allergy Either (1) aztreonam plus levofloxacin, l or (2) aztreonam plus moxifloxacin or gatifloxacin, with or without an aminoglycoside Nursing home Receiving treatment in nursing home A respiratory fluoroquinolone alone or amoxicillin-clavulanate plus an advanced macrolide Hospitalized Same as for medical ward and ICU NOTE. COPD, chronic obstructive pulmonary disease; ICU, intensive care unit. a Erythromycin, azithromycin, or clarithromycin.