CPG Management and Prevention of Adult Community Acquired Pneumonia (2020)
Clinical Practice Guidelines Management and Prevention of Adult Community Acquired Pneumonia
Community acquired pneumonia is a significant cause of morbidity and mortality among adults, still remaining as the leading cause of death from an infectious disease. Since the last publication of Philippine Clinical Practice Guidelines on the Diagnosis, Empiric Management, and Prevention of Community-acquired Pneumonia in Immunocompetent Adults in 2016, several important changes have emerged, including increasing rates of multi-drug resistant organisms (MDROs) among respiratory pathogens, the development of new antimicrobial agents meant to address these MDROs, the misuse and overuse of antimicrobial agents. It is for these reasons that an update on the management of CAP is needed.
The following are the guideline’s objectives:
- To provide an evidence–based approach to the empiric antimicrobial management and prevention of CAP in adults to help standardize care
- To update the 2016 Philippine CPG on CAP in Adults with recent and up-to-date medical evidences on new developments at the global level yet localizing it in the Philippine setting, including the increasing rates of MDROs among respiratory pathogens and the development of new antimicrobial agents meant to address these MDROs
This guideline is intended for use of medical specialists in infectious diseases, pulmonology, family medicine, as well as general practitioners, clinical practitioners, nurses and other health care providers as well as administrators, and policy makers. It can be used in the hospital and community setting—from primary to tertiary level in both private and government clinics or hospitals.
The guideline shall cover all adults, including the elderly, presenting with CAP in the outpatient and in-patient setting except:
- CAP occurring in immunocompromised patient including bone marrow, solid organ or stem cell recipient
- Patients receiving cancer chemotherapy or immune-modulators
- Long term high dose corticosteroid >30days (> or = 20mg/day prednisone or its equivalent)
- Patients with congenital and acquired immunodeficiency (including cystic fibrosis, autoimmune and HIV)
- Pneumonia in children < 18 years old
- Pulmonary tuberculosis co-infection
There are 17 priority questions identified and 30 corresponding recommendations developed by a group of experts composed of an Oversight Committee, a Guideline Writing Panel and a Technical Review Committee (Table 1). Based on the best available evidences, the quality and strength of evidence was rated using the Grading of Recommendations, Assessment, Development and evaluation (GRADE) approach. Draft recommendations were finalized after these were presented to and voted on by the members of the Consensus Panel.