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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, October 10, 2016

IDSA Pneumonia Update

R.E.B.E.L.EM - Posted by Anand Swaminathan
"Every few years we get updates in the guidelines based on new evidence. Guidelines give us a framework to work with in the treatment of disease processes, such as pneumonia. The last Infectious Disease Society of America (IDSA) guidelines update on the treatment of pneumonia came from 2005, but recently, the new 2016 guidelines were just published. This was a massive 51 page summary that starts off by saying:
“It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be VOLUNTARY, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.”...
Clinical Bottom Line:
Where does this leave us in terms of HCAP, a more relevant area in Emergency Medicine than HAP and VAP. The truth is that we don’t know. As mentioned in the podcast, many of us see patients who were recently admitted for unrelated issues who now return with pneumonias but are very well appearing and without significant comorbid conditions. Uniformly, admitting these patients and treating them with broad spectrum antibiotics never made sense. It will be interesting to see what subsequent IDSA recommendations are for the treatment of HCAP and how this affects our treatment decisions. For now, in well appearing patients who are otherwise healthy with unremarkable vital signs, we are recommending treating HCAP in the same way we treat community acquired pneumonia and ensuring close follow up and giving explicit return precautions."