Minimize microbiology (no sputum/BC unless severe of MDRO Rx)
Don't base initial Rx on PCT
Don't use steroids
Macrolides for outpts ONLY if low resistance
Stop using "HCAP"
Severe CAP: BL+macrolide OR FQ
No routine F/U CXR
Used GRADE and PICO frameworks--they chose questions (remarkably, no Q on need for Legionella/atypical coverage)
Lit. search carried out from 2015-2017 w/monthly searches in between
2 papers from 2019: LEAP 1 (iv-to-po lefamulin) and omadacycline vs. moxi)
❌ how much of CAP is non-bacterial
❌do we need to routinely cover for atypical CAP
✅ can we use biomarkers to determine treatment for CAP
✅ how long do we have to treat with ABx
Independent of industry funding
Subgroups met, drafted guidelines, based on available evidence +/- meta-analysis
They use 2007 IDSA/ATS severity criteria. In fact, one of the co-chairs said as much in 2017.atsjournals.org/doi/full/10.11…
Similarly, they discourage routine procalcitonin measurements for deciding Rx, and I would agree with that, too.
The amazing thing: nowhere in continental US is macrolide resistance <25%. .
beta-lactam (including amp/sulbactam, 3o ceph or + CEFTAROLINE) + macrolide
(and I they managed to mention omadacycline)
This seems an impossible task: to come up with CAP guidelines that most would agree with. I think if they could have a) overcome process and time issues, b) were disciplined in how they used evidence, and c) included stewards, these CPGs would have been better.