美國胸腔學會於2019年10月1日發佈”肺炎診斷和診治指引” :1.健康照護相關肺炎(health care–associated pneumonia,(HCAP))病例,不建議使用抗生素治療; 2.無共病或帶危險因子的門診病人,建議使用 amoxicillin 或 doxycycline治療,社區型肺炎(community-acquired pneumonia (CAP)) 門診病人若僅局部對治療肺炎鏈球菌的巨環類類抗生素(Macrolides)具抗藥性,建議可使用巨環類類抗生素(azithromycin or clarithromycin)治療;3.有慢性疾病的社區型肺炎門診病人建議使用β-lactam (amoxicillin-clavulanate or cephalosporin)合併使用macrolide或 doxycycline、或單一開立fluoroquinolone治療,治療時間為5-7天;4.輕症社區型肺炎住院病人,若無methicillin金黃色葡萄球菌抗藥性 (formethicillin-resistant Staphylococcus aureus (MRSA) 或 Pseudomon asaeruginosa), 建議以β-lactam 合併使用amacrolide 或單一開立fluoroquinolone治療,但禁止同時開立macrolides and fluoroquinolones或 β-lactam and doxycycline;5.重症社區型肺炎住院病人若無MRSA 或 P asaeruginosa,建議以β-lactam 合併使用amacrolide 或fluoroquinolone治療;6.流感快篩僅適用於當社區群聚感染發生時,具陽性反應之個案,應接受抗病毒藥物治療;7.醫師應依據肺炎嚴重度指標值(pneumonia severity index, 作為判斷個案應接受門診或住院治療之依據。

(財團法人國家衛生研究院 蔡慧如博士摘要整理)

Summary of the Clinical Problem

CAP is an infection of the pulmonary parenchyma acquired outside of a health care setting. CAP is common, with more than 1.5 million adults hospitalized annually, and is the most common infectious cause of death in the US.1

CAP is a heterogeneous illness, both in illness severity and pathogens. The most common bacterial pathogens are Streptococcus pneumoniaeHaemophilus influenzaeMycoplasma pneumoniaeS aureusLegionella species, Chlamydia pneumoniae, and Moraxella catarrhalis. However, the microbiologic etiology of CAP is evolving, with increasing recognition of the role of viral pathogens using molecular detection methods.

Characteristics of the Guideline Source

The guideline was developed by the ATS and IDSA.2 They convened a 15-member panel of pulmonologists, infectious disease specialists, general internists, and methodologists with expertise in evidence synthesis. Members disclosed all potential conflicts of interest. The guideline is presented as a series of clinical questions, using the Patient or Population, Intervention, Comparison, Outcome (PICO) framework. Given the broad scope of the topic, the guideline was intentionally narrowed to cover clinical decisions from the time of diagnosis of pneumonia through treatment and follow-up imaging. It does not address initial diagnosis or prevention.

Evidence Base

For most topics, 2 methodologists conducted a systematic review, performed evidence synthesis, and prepared evidence summaries following the GRADE approach. For each question addressed by the methodologists, MEDLINE was searched for relevant literature, with meta-analysis performed when possible to obtain estimates of effects on each outcome of interest.

Author:Gregory Olson, Andrew M Davis
原文連結:https://jamanetwork.com/journals/jama/fullarticle/2760882

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