Guidelines for empiric antimicrobial prescribing in community-acquired pneumonia

Thomas M. File, Javier Garau, Francesco Blasi, Christian Chidiac, Keith Klugman, Hartmut Lode, John R. Lonks, Lionel Mandell, Julio Ramirez, Victor Yu

Research output: Contribution to journalArticlepeer-review


Empiric antimicrobial prescribing for community-acquired pneumonia remains a challenge, despite the availability of treatment guidelines. A number of key differences exist between North American and European guidelines, mainly in the outpatient setting. The North American approach is to use initial antimicrobial therapy, which provides coverage for Streptococcus pneumoniae plus atypical pathogens. Europeans tend to focus on providing pneumococcal coverage with less emphasis on covering for an atypical pathogen. Ambulatory patients without comorbidity are more likely to receive macrolide therapy in North America, whereas in Europe these patients would probably receive a β-lactam agent. Major issues that are fundamental to this difference include the importance of providing therapy for atypical pathogens and the clinical significance of macrolide-resistant S pneumoniae. Prospective data are required to evaluate which of these two approaches offers clinical superiority.

Original languageEnglish
Pages (from-to)1888-1901
Number of pages14
Issue number5
Publication statusPublished - May 2004


  • Antibiotic resistance
  • Community-acquired pneumonia
  • Empiric prescribing
  • Management guidelines

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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