Initial Selection of Antibiotic Therapy for Community Acquired Pneumonia in Adults

David L Longworth, Muzaffar Ahmad



Patients with community acquired pneumonia must often be treated in the absence of a definitive microbiologic diagnosis. The optimal choice of antibiotic therapy depends on the patient's age, season of the year, onset of symptoms, underlying illnesses, epidemiological features, x-ray patterns, and the local prevalence of pathogens. The issues related to antibiotic cost and toxicity are also important considerations. Streptococcus penumoniae remains the most common etiologic agent among community acquired pneumonias, however, in a significant percentage of cases no definite etiologic agent is identified. The incidence of Mycoplosma penumonia is dependent on the occurrence of epidemics and that of Legionnories' Disease on the geographic area and the time of the year. Community acquired pneumonias may be divided into typical bacterial pneumonias or atypical pneumonias. Patients with a typical bacterial pneumonia and a compatible history, chest radiography, and sputum gram stain for penumococcal pneumonia should be treated with penicillin G. Those who present with atypical pneumonia may be initially treated with Erythromycin to cover both Mycoplasma and Legionella. Risk factors for infection with human immunodeficiency virus should be elicited in every patient since the likely pathogens are very different with Pneumocystis carinii leading the list.

Presented at the IMA 22nd Annual Convention Orlando, Florida, July 1989. Part of Symposium: Update on the Diagnosis and Treatment of Respiratory Tract Infection


Antibiotics; Pneumonia; Therapy

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