Rapid Clinical Updates: Antibiotic Stewardship in Pneumonia-Handout

Handout

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This rapid clinical update focuses on antibiotic stewardship in the management of community-acquired pneumonia (CAP), emphasizing accurate diagnosis, laboratory testing, and optimized antibiotic use.<br /><br />Diagnosis: Overdiagnosis is common, with 10–30% of treated patients not meeting CAP criteria. Clinicians should ensure clinical and radiographic evidence supports the diagnosis, using current definitions. Differentiating severity (severe vs. non-severe, complicated vs. uncomplicated) guides treatment. Importantly, patients from nursing homes should not be automatically classified as healthcare-associated pneumonia (HCAP).<br /><br />Laboratory Stewardship: Lab testing should be limited to avoid unnecessary workup. Blood and respiratory cultures are recommended only if sepsis or another indication exists. Urinary antigen tests should be restricted: Streptococcus pneumoniae antigen testing only for severe cases and Legionella antigen only during outbreaks or recent travel. Viral testing (influenza, COVID-19) should be performed based on community prevalence.<br /><br />Antimicrobial Stewardship: Guidelines call for antibiotic therapy of at least 5 days traditionally, usually with a macrolide plus beta-lactam regimen. Recent studies support shorter courses—3 days of antibiotics are non-inferior in clinically stable patients (meeting stability criteria of no fever, heart rate <100, respiratory rate <24, oxygen saturation >90%, systolic BP >90 mmHg). Staphylococcus aureus and Pseudomonas infections require longer therapy (7 days). Empiric anaerobic coverage for aspiration pneumonia is generally unnecessary. Incorporating electronic order sets to step down to oral antibiotics early reduces duration and cost.<br /><br />Additional Notes: Negative MRSA screening has a high negative predictive value and can guide early de-escalation if cultures are pending.<br /><br />Overall, integrating current diagnostic criteria, limiting unnecessary lab tests, and applying updated antibiotic durations and stewardship principles improves care quality, reduces overtreatment, and optimizes outcomes in pneumonia management.

Keywords

antibiotic stewardship

community-acquired pneumonia

CAP diagnosis

laboratory testing guidelines

antimicrobial therapy duration

macrolide and beta-lactam regimen

severity differentiation in pneumonia

MRSA screening

electronic order sets

aspiration pneumonia management