Skip to main content
SpringerLink
Log in

Diagnosis and treatment of community acquired pneumonia - the German perspective

  • Chapter
Community-Acquired Pneumonia

Part of the book series: Birkhäuser Advances in Infectious Diseases ((BAID))

Abstract

Current concepts of diagnosis and treatment of CAP are risk stratified and adapted to the national resistances of important pathogens. Thorough surveillance systems have to be implemented in all countries.

The risk of patients can be assessed reliably with a limited number of clinical data (CRB-65 score). Extended microbiological and laboratory diagnosis is recommended for hospitaliszed patients only. Outpatient treatment can be performed with classic antibiotics like amoxicillin or doxycyclin. Macrolides are only an alternative in these patients. In the hospital, treatment has to be adapted to the severity of the disease. Further studies concerning the duration of treatment and advantageous combinations are necessary.

Recommendations for treatment of CAP have to be adapted to the quickly changing epidemiology and have to be updated every 2 to 3 years.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Lopez AD, Murray CC (1998) The global burden of disease. Nat Med 4: 1241–1243

    Article  PubMed  CAS  Google Scholar 

  2. Center for Disease Control and Prevention (1997) Premature deaths, monthly mortality and monthly physician contacts-United States. MMWR Morb Mortal Wkly Rep 46: 556

    Google Scholar 

  3. Marston BJ, Plouffe JF, File TM Hackman BA, Salstrom SJ, Lipman HB, Kolczak MS, Breiman RF (1997) Incidence of community-acquired pneumonia requiring hospitalization. Arch Intern Med 157(15): 1709–1718

    Article  PubMed  CAS  Google Scholar 

  4. Bartlett JG, Dowell SF, Mandell LA, File TM Jr, Musher DM, Fine MJ (2000) Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis 31: 422–425

    Article  Google Scholar 

  5. Lim WS, Macfarlane JT, Boswell TC, Harrison TG, Rose D, Leinonen M, Saikku P (2001) SCAPA: Study of Community Acquired Pneumonia Aetiology in adults admitted to hospital: implications for management guidelines. Thorax 56: 296–301

    Article  PubMed  CAS  Google Scholar 

  6. Arancibia F, Bauer TT, Ewig S, Mensa J, Gonzalez J, Niederman MS, Torres A (2002) Community-acquired pneumonia due to gram-negative bacteria and Pseudomonas aeruginosa: incidence, risk, and prognosis. Arch Intern Med 162: 1849–1858

    Article  PubMed  Google Scholar 

  7. Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, Kapoor WN (1996) Prognosis and outcome of patients with community acquired pneumonia. JAMA 275: 134–141

    Article  PubMed  CAS  Google Scholar 

  8. Osler W (1901) Lobar pneumonia. In: J Young (ed) The principles and practice of medicine. Pentland, Edinburgh & London, 126–129

    Google Scholar 

  9. American Thoracic Society; Infectious Diseases Society of America (2005) Guidelines for the management of adults with hospital-acquired, ventilatorassociated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171(4): 388–416

    Article  Google Scholar 

  10. Syrjala H, Broas M, Suramo I (1998) High-resolution computed tomography for the diagnosis of community-acquired pneumonia. Clin Infect Dis 27: 358–363

    PubMed  CAS  Google Scholar 

  11. Bartlett JG, Breiman RF, Mandell LA, File TM (1998) Community-acquired pneumonia in adults: Guidelines for management. Clin Infect Dis 26: 811–838

    PubMed  CAS  Google Scholar 

  12. Woodhead M, Blasi F, Ewig S, Huchon G, Leven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Verheij TJ (2005) Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 26(6): 1138–1180

    Article  PubMed  CAS  Google Scholar 

  13. Metlay JP, Schulz R, Li YH, Singer DE, Marrie TJ, Coley CM, Hough LJ, Obrosky DS, Kapoor WN, Fine MJ (1997) Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med 157(13): 1453–1459

    Article  PubMed  CAS  Google Scholar 

  14. Welte T, Suttorp N, Marre R (2004) CAPNETZ-community-acquired pneumonia competence network. Infection 4: 234–238

    Google Scholar 

  15. Welte T, Marre R, Suttorp N; for the CAPNETZ Network (2006) What is new in the treatment of community-acquired pneumonia? Med Klin (Munich) 101(4): 313–320

    Article  Google Scholar 

  16. El-Solh AA, Sikka P, Ramadan F, Davies J (2001) Etiology of severe pneumonia in the very elderly. Am J Respir Crit Care Med 163: 645–651

    PubMed  CAS  Google Scholar 

  17. Blasi F (2004) Atypical pathogenes and respiratory tract infections. Eur Respir J 24: 171–181

    Article  PubMed  CAS  Google Scholar 

  18. De Roux A, Marcos MA, Garcia E, Mensa J, Ewig S, Lode H, Torres A (2004) Viral community-acquired pneumonia in nonimmunocompromised adults. Chest 125: 1343–1351

    Article  PubMed  Google Scholar 

  19. Nichol KL, Wuorenma J, von Sternberg T (1998) Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Arch Intern Med 158: 1769–1776

    Article  PubMed  CAS  Google Scholar 

  20. Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, Reingold A, Cieslak PR, Pilishvili T, Jackson D et al (2003) Active bacterial core surveillance of the emerging infections program network. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 348(18): 1737–1746

    Article  PubMed  Google Scholar 

  21. Felmingham D, Reinert RR, Hirakata Y, Rodloff A (2002) Increasing prevalence of antimicrobial resistance among isolates of Streptococcus pneumoniae from the PROTEKT surveillance study, and compatative in vitro activity of the ketolide, telithromycin. J Antimicrob Chemother 50 Suppl S1: 25–37

    PubMed  CAS  Google Scholar 

  22. Goossens H, Ferech M, Vander Stichele R, Elseviers M (2005) Outpatient antibiotic use in Europe and association with resistance: a cross national database study. Lancet 365: 579–587

    PubMed  Google Scholar 

  23. Yu VL, Chiou CC, Feldman C, Ortqvist A, Rello J, Morris AJ, Baddour LM, Luna CM, Snydman DR, Ip M et al.; International Pneumococcal Study Group (2003) An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. Clin Infect Dis 37(2): 230–237

    Article  PubMed  CAS  Google Scholar 

  24. Lonks JR, Garau J, Gomez L, Xercavins M, Ochoa de Echaguen A, Gareen IF, Reiss PT, Medeiros AA (2002) Failure of macrolide antibiotic treatment in patients with bacteremia due to erythromycin-resistant Streptococcus pneumoniae. Clin Infect Dis 35 (5): 556–564

    Article  PubMed  CAS  Google Scholar 

  25. Davidson R, Cavalcanti R, Brunton JL, Bast DJ, de Azavedo JCS, Kibsey P, Fleming C, Low DE (2002) Resistance to Levofloxacin and failure of treatment of pneumococcal pneumonia. N Engl J Med 346: 747–750

    Article  PubMed  Google Scholar 

  26. Seppala H, Klaukka T, Vuopio-Varkila J (1997) The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. N Engl J Med 337: 441–446

    Article  PubMed  CAS  Google Scholar 

  27. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN (1997) A prediction rule to identify low-risk patients with community acquired pneumonia. N Engl J Med 336: 243–250

    Article  PubMed  CAS  Google Scholar 

  28. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT (2003) Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58: 377–382

    Article  PubMed  CAS  Google Scholar 

  29. Capelastegui A, Espana PP, Quintana JM, Areitio I, Gorordo I, Egurrola M, Bilbao A (2006) Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J 27(1): 151–157

    Article  PubMed  CAS  Google Scholar 

  30. Bauer T, Ewig S, Marre R, Suttorp N, Welte T (2006) CURB and CRB-65 scores predict mortality in hospitalised and out-patients with communityacquired pneumonia (CAP). J Intern Med 260: 93–101

    Article  PubMed  CAS  Google Scholar 

  31. Ewig S, de Roux A, Bauer T, Garcia E, Mensa J, Niederman M, Torres A (2004) Validation of predictive rules and indices of severity for community acquired pneumonia. Thorax 59 (5): 421–427

    Article  PubMed  CAS  Google Scholar 

  32. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, Muller B (2004) Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, singleblinded intervention trial. Lancet 363: 600–607

    Article  PubMed  CAS  Google Scholar 

  33. Ishida T, Hashimoto T, Arita M, Tojo Y, Tachibana H, Jinnai M (2004) A 3-year prospective study of a urinary antigen-detection for Streptococcus pneumoniae in community acquired pneumonia: utility and clinical impact on the reported etiology. J Infect Chemother 10: 359–363

    Article  PubMed  CAS  Google Scholar 

  34. Menendez R, Torres A, Zalacain R, Aspa J, Martin Villasclaras JJ, Borderias L, Benitez Moya JM, Ruiz-Manzano J, Rodriguez de Castro F, Blanquer J et al.; Neumofail Group (2004) Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax 59(11): 960–965

    Article  PubMed  CAS  Google Scholar 

  35. Janssens JP (2005) Pneumonia in the elderly (geriatric) population. Curr Opin Pulm Med 11(3): 226–230

    Article  PubMed  Google Scholar 

  36. Sethi S, Evans N, Grant BJ, Murphy TF (2002) New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med 347(7): 465–471

    Article  PubMed  Google Scholar 

  37. Mills GD, Oehley MR, Arrol B (2005) Effectiveness of beta lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis. BMJ 330: 456

    Google Scholar 

  38. Guchev IA, Yu VL, Sinopalnikov A, Klochkov OI, Kozlov RS, Stratchounski LS (2005) Management of nonsevere pneumonia in military trainees with the urinary antigen test for Streptococcus pneumoniae: an innovative approach to targeted therapy. Clin Infect Dis 40: 1608–1616

    Article  PubMed  Google Scholar 

  39. Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG (2000) A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA 283: 749–755

    Article  PubMed  CAS  Google Scholar 

  40. Baddour LM, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, Morris AJ, Luna CM, Syndman DR, Ko WC et al (2004) Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 170: 440–444

    Article  PubMed  Google Scholar 

  41. Welte T, Petermann W, Schuermann D, Bauer TT, Reimnitz P, Moxirapid Study Group (2005) Treatment with sequential intravenous/oral moxifloxacin was associated with faster clinical improvement compared to standard therapy in hospitalized CAP patients with initial parenteral therapy. Clin Infect Dis 41(12): 1697–1705

    Article  PubMed  CAS  Google Scholar 

  42. Paul M, Benuri-Silbiger I, Soares-Weiser K, Leibovici L (2004) β-lactam monotherapy versus β-lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials. BMJ 328: 668

    Google Scholar 

  43. Safdar N, Handelsman J, Maki DG (2004) Does combination antimicrobial therapy reduce mortality in gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis 4: 519–527

    Article  PubMed  Google Scholar 

  44. Torres A, Read R, Lode H, Carlet J, Winter JH, Garau J, Welte T, Arvis P, Le Berre MA, Choudhri SH (2006) Once daily sequential intravenous/oral (IV/ PO) moxifloxacin is equivalent to IV ceftriaxone plus twice daily IV/PO levofloxacin in the treatment of severe community-acquired pneumonia requiring hospitalization: the MOTIV study. ECCMID 2006

    Google Scholar 

  45. Dunbar LM, Wunderink RG, Habib MP, Smith LG, Tennenberg AM, Khashab MM, Wiesinger BA, Xiang JX, Zadeikis N, Kahn JB (2003) High-dose, shortcourse levofloxacin for community-acquired pneumonia: a new treatment paradigm. Clin Infect Dis 37: 752–760

    Article  PubMed  CAS  Google Scholar 

  46. Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, Dean N, File T, Fine MJ, Gross PA et al (2001) Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 163: 1730–1754

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pulmonary Medicine, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Tobias Welte

Authors
  1. Tobias Welte
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Birkhäuser Verlag Basel/Switzerland

About this chapter

Cite this chapter

Welte, T. (2007). Diagnosis and treatment of community acquired pneumonia - the German perspective. In: Community-Acquired Pneumonia. Birkhäuser Advances in Infectious Diseases. Birkhäuser Basel. https://doi.org/10.1007/978-3-7643-7563-8_1

Download citation

Publish with us

Policies and ethics

Search

Navigation