一般社団法人日本呼吸器学会 公式サイト
日本呼吸器学会英文誌 Respiratory Investigation
日本呼吸器学会誌 増刊号 学術講演会プログラム 抄録集 検索用
日本呼吸器学会誌 増刊号 学術講演会プログラム 抄録集 全文PDF

Abstract

Full Text of PDF Full Text of PDF (1411k)
Article in Japanese

Topics Series Infectious Disease: Pneumonia

The essentials of antibiotics selection for CAP, NHCAP, and VAP

Kazunori Tomono 

Division of Infection Control and Prevention, Osaka University Hospital

ABSTRACT

The initial empiric therapy for pneumonia was started based on knowledge of the epidemiological data of predominant pathogens in specific clinical settings and the local patterns of antibiotic susceptibility. The Japanese guidelines for empirical treatment of patients with pneumonia provide recommendations for antibiotic selections that are primarily based on age, presence of underlying diseases, and severity of pneumonia. Moreover, in cases of old or healthcare-associated patients, multidrug-resistant organisms (MDROs) are also important predictors of patient morbidity and mortality. Younger patients with a mild disease can be adequately treated with a drug that covers either bacterial or atypical pathogens alone, which is diagnosed by criteria provided by the Japanese CAP guideline. Older patients or those with preexisting illnesses, including hospitalized patients, are more likely to have infections with MDROs, and any antibiotic therapy should be aimed primarily against these organisms. For nonresponding patients, empiric antibiotics may need modification to escalation, especially in younger and moderate patients. When a patient is responding appropriately, therapy can be deescalated or narrowed if an anticipated organism is not recovered or if the organism isolated is sensitive to an antibiotic with a spectrum that is smaller than the one used in the initial regimen. Considering the will of the individuals and the aging of modern Japanese society, we must again consider the concepts of “escalation” and “deescalation” of antibiotic selections for treatment of pneumonia.

KEYWORDS

Guidelines for the management of pneumonia  Antibiotic selection  Escalation  De-escalation  Drug resistant bacteria 

AJRS, 2(6): 695-702, 2013

Google Scholar