Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia

Lee, Mi Suk; Oh, Jee Youn; Kang, Cheol-In; Kim, Eu Suk; Park, Sunghoon; Rhee, Chin Kook; Jung, Ji Ye; Jo, Kyung-Wook; Heo, Eun Young; Park, Dong-Ah; Suh, Gee Young; Kiem, Sungmin

There is a controversy regarding whether or not antibiotics that target the causative bacterial of atypical pneumonia should be used in the treatment of mild community-acquired pneumonia that does not require hospitalization. In a retrospective study secondarily conducted using the Community-Acquired Pneumonia Organization (CAPO) database registered at the multi-institutional phase-three clinical trial conducted in various countries, antibiotics that were effective against the causative bacteria of atypical pneumonia showed more excellent outcomes in terms of mortality rate and clinical progress [129] . The study reported that the antibiotic treatment of the causative bacteria of atypical pneumonia is advisable for all patients with community-acquired pneumonia in terms of their mortality rates and treatment outcome. In addition, the IDSA/ATS guideline on pneumonia treatment developed in the United States in 2007 also gives the same recommendation. However, in a meta-analysis of patients with mild community-acquired pneumonia, use of a single antibiotic targeting the causative bacteria of atypical pneumonia had poorer clinical results than the use of β-lactam alone [130] , and similar results were also reported by the 2010 Cochrane review on patients hospitalized due to community-acquired pneumonia [131] . In a study published in 2015, the β-lactam monotherapy was not inferior to the β-lactam + macrolide combination therapy [132] . Therefore, this guideline recommends using macrolide in addition to β-lactam only in cases of suspected atypical pneumonia.