Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. (Evidence-based guideline)

Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.

Discipline Area Score
Family Medicine (FM)/General Practice (GP) 7 / 7
General Internal Medicine-Primary Care(US) 7 / 7
Hospital Doctor/Hospitalists 7 / 7
Internal Medicine 7 / 7
Geriatrics 6 / 7
Infectious Disease 6 / 7
Respirology/Pulmonology 6 / 7
Comments from MORE raters

General Internal Medicine-Primary Care(US) rater

Outstanding reference for generalist practitioners. This is a must-read!

Geriatrics rater

The new recommendations are broken down by clinical scenario and offer customizable regimens as well as the level of evidence supporting each recommendation. Changes from the previous guideline are clearly displayed in a table.

Hospital Doctor/Hospitalists rater

Most doctors will know much of what is said in this article, but given that this is one of the most common admitting diagnoses in hospitalized adults, the guidelines are newsworthy.

Infectious Disease rater

The biggest news in the guidelines are the official elimination of the HCAP category, which has been anticipated for a long time. The guidelines have some unique aspects such as encouraging hospitals to derive their local risk factors for pneumonia caused by P. aeruginosa and MRSA (or validate existing risk factors from the literature). This is particularly important given the vast differences across healthcare systems. The document is quite strong on antimicrobial management, but falls short of expectations on diagnostic work-up.

Infectious Disease rater

This is a very important and relevant CAP update to most internal medicine clinicians. The main strength of this guideline is the removal of so many outdated recommendations from the previous version, while the limitations are related to the PICO questions that were not included in this new guideline. Overall, this 2019 update is a welcome and useful addition to our clinical tools for the care of patients with CAP.

Infectious Disease rater

All providers should be made aware of these updated recommendations.

Internal Medicine rater

I think their initial comment that "this is a heterogenous" illness explains why there are so many guidelines and recommendations for this condition. Frankly, CAP doesn`t seem to be as complicated as the guidelines.

Internal Medicine rater

Definitely an important guideline for internists.

Internal Medicine rater

Most useful guidelines for evaluation and management of pneumonia in the community and hospital setting based on extensive review of published literature using GRADE and PICO frameworks.

Respirology/Pulmonology rater

As a pulmonologist, the guidelines for managing community-acquired pneumonia provide important updates. It is especially relevant that the HCAP definition has been retired and the treatment recommendations are now based on risk factors for MRSA and pseudomonas. It also highlights the lack of evidence for using antibiotics to cover anaerobic organisms in patients with suspected aspiration pneumonia. The guidelines also recommend treatment of influenza in inpatients who test positive, irrespective of the duration of illness before diagnosis. Moreover, those patients should also receive standard bacterial antimicrobial treatment.

Respirology/Pulmonology rater

Outstanding overview answering critical questions in pursuing appropriate treatment of CAP. Outstanding grading of quality of evidence and strength of recommendations.
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