Skip to main content
Top
Published in:

Open Access 01-12-2017 | Research Article

Antibiotic therapy, supportive treatment and management of immunomodulation-inflammation response in community acquired pneumonia: review of recommendations

Authors: Marco Mantero, Paolo Tarsia, Andrea Gramegna, Sonia Henchi, Nicolò Vanoni, Marta Di Pasquale

Published in: Multidisciplinary Respiratory Medicine | Issue 1/2017

Login to get access

Abstract

Community-acquired pneumonia is a common and serious disease, with high rates of morbidity and mortality. Management and treatment of community-acquired pneumonia are described in three main documents: the 2007 American Thoracic Society guidelines, the 2011 European Respiratory Society guidelines, and the 2009 British Thoracic Society guidelines, updated by the NICE in 2015. Despite the validity of current guidelines in improving prognosis and management of patients with community-acquired pneumonia, not all recommendations have high levels of evidence and there are still some controversial issues. In particular, there are some areas of low evidence such as the efficacy of an antibiotic molecule or scheme in patients with same risk factors; duration of antibiotic treatment, supportive therapy for acute respiratory failure and immunomodulation molecules.
This review will summarize the main recommendations with high level of evidence and discuss the recommendations with lower evidence, analyzing the studies published after the guidelines’ release.
Literature
1.
go back to reference Niederman MS. Community-acquired pneumonia: the U.S. perspective. Semin Respir Crit Care Med. 2009;30(2):179–88.CrossRefPubMed Niederman MS. Community-acquired pneumonia: the U.S. perspective. Semin Respir Crit Care Med. 2009;30(2):179–88.CrossRefPubMed
2.
go back to reference Goss CH, Rubenfeld GD, Park DR, Sherbin VL, Goodman MS, Root RK. Cost and incidence of social co-morbidities in low-risk patients with community-acquired pneumonia admitted to a public hospital. Chest. 2003;124(6):2148–55.CrossRefPubMed Goss CH, Rubenfeld GD, Park DR, Sherbin VL, Goodman MS, Root RK. Cost and incidence of social co-morbidities in low-risk patients with community-acquired pneumonia admitted to a public hospital. Chest. 2003;124(6):2148–55.CrossRefPubMed
3.
go back to reference Woodhead M, Blasi F. S Ewing, Garau J, G Huchon, Ieven M, et al. Guidelines for the management of adult lower respiratory tract infections. Clin Microbiol Infect. 2011;17(Suppl. 6):E1–E59.CrossRefPubMed Woodhead M, Blasi F. S Ewing, Garau J, G Huchon, Ieven M, et al. Guidelines for the management of adult lower respiratory tract infections. Clin Microbiol Infect. 2011;17(Suppl. 6):E1–E59.CrossRefPubMed
4.
go back to reference Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America / American Thoracic Society consensus guidelines on the management of community acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27–72.CrossRefPubMed Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America / American Thoracic Society consensus guidelines on the management of community acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27–72.CrossRefPubMed
5.
go back to reference Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune i, et al. British Thoracic Societyg guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64:SIII. Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune i, et al. British Thoracic Societyg guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64:SIII.
6.
go back to reference Blasi F, Garau J, Medina J, Ávila M, McBride K, Ostermann H. Current management of patients hospitalized with community-acquired pneumonia across Europe: outcomes from REACH. Respir Res. 2013;14:44.CrossRefPubMedPubMedCentral Blasi F, Garau J, Medina J, Ávila M, McBride K, Ostermann H. Current management of patients hospitalized with community-acquired pneumonia across Europe: outcomes from REACH. Respir Res. 2013;14:44.CrossRefPubMedPubMedCentral
7.
go back to reference Dean NC, Silver MP, Bateman KA, Brent J, Hadlock CJ, Hale D. Decreased mortality after implementation of a treatment guideline for community-acquired pneumonia. Am J Med. 2011;110:451–7.CrossRef Dean NC, Silver MP, Bateman KA, Brent J, Hadlock CJ, Hale D. Decreased mortality after implementation of a treatment guideline for community-acquired pneumonia. Am J Med. 2011;110:451–7.CrossRef
8.
go back to reference Torres A, Sibila O, Ferrer M, Polverino E, Menendez R, Mensa J, et al. Effect of corticosteroids on treatment failure among patients hospitalized with severe community acquired pneumonia. A randomized clinical trial. JAMA. 2015;313(7):677–86.CrossRefPubMed Torres A, Sibila O, Ferrer M, Polverino E, Menendez R, Mensa J, et al. Effect of corticosteroids on treatment failure among patients hospitalized with severe community acquired pneumonia. A randomized clinical trial. JAMA. 2015;313(7):677–86.CrossRefPubMed
9.
go back to reference Blum CA, Nigro N, Brief M, Schuetz P, Ullmer A, Suter-Widmer I, et al. Adjunct prednisone therapy for patients with community acquired pneumonia: a multicentre, double- blind randomized, placebo-controlled trial. Lancet. 2015;385:1511–8.CrossRefPubMed Blum CA, Nigro N, Brief M, Schuetz P, Ullmer A, Suter-Widmer I, et al. Adjunct prednisone therapy for patients with community acquired pneumonia: a multicentre, double- blind randomized, placebo-controlled trial. Lancet. 2015;385:1511–8.CrossRefPubMed
10.
go back to reference Wan YD, Sun TW, Liu ZQ, Zhang SG, Wang LX, Kan QC. Efficacy and safety of corticosteroids for community acquired pneumonia in systematic review and meta-analysis. Chest. 2016;149(1):209–19.CrossRefPubMed Wan YD, Sun TW, Liu ZQ, Zhang SG, Wang LX, Kan QC. Efficacy and safety of corticosteroids for community acquired pneumonia in systematic review and meta-analysis. Chest. 2016;149(1):209–19.CrossRefPubMed
11.
go back to reference Niet W, Li B, Xiu Q. β-Lactam / macrolide dual β-Lactam therapy versus monotherapy for the treatment of community-acquired pneumonia in adults: a systematic review and meta-analysis. J Antimicrob Chemother. 2014;69:1441–6.CrossRef Niet W, Li B, Xiu Q. β-Lactam / macrolide dual β-Lactam therapy versus monotherapy for the treatment of community-acquired pneumonia in adults: a systematic review and meta-analysis. J Antimicrob Chemother. 2014;69:1441–6.CrossRef
12.
go back to reference Postma DF, van Werkhoven CH, Van Elden LJR, Thijsen SFT, Hopelman AIM, Kluytmans JAJW, et al. Antibiotic treatment strategies for community acquired pneumonia in adults. N Engl J Med. 2015;372:1312–23.CrossRefPubMed Postma DF, van Werkhoven CH, Van Elden LJR, Thijsen SFT, Hopelman AIM, Kluytmans JAJW, et al. Antibiotic treatment strategies for community acquired pneumonia in adults. N Engl J Med. 2015;372:1312–23.CrossRefPubMed
13.
go back to reference Garin N, Genné D, Carballo S, Chuard C, Eich G, Hugli O, et al. β-Lactam monotherapy vs β-Lactam-macrolide combination treatment in moderately severe community-acquired pneumonia: a randomized non-inferiority trial. JAMA Intern Med. 2014;174(12):1894–901.CrossRefPubMed Garin N, Genné D, Carballo S, Chuard C, Eich G, Hugli O, et al. β-Lactam monotherapy vs β-Lactam-macrolide combination treatment in moderately severe community-acquired pneumonia: a randomized non-inferiority trial. JAMA Intern Med. 2014;174(12):1894–901.CrossRefPubMed
14.
go back to reference Vardakas KZ, Trigkidis KK, Falagas ME. Fluoroquinolones or macrolides in combination with β-Lactams in adult patients hospitalized with community acquired pneumonia: a systematic review and meta-analysis. Clin Microbiol Infect. 2017;23(4):234–41.CrossRefPubMed Vardakas KZ, Trigkidis KK, Falagas ME. Fluoroquinolones or macrolides in combination with β-Lactams in adult patients hospitalized with community acquired pneumonia: a systematic review and meta-analysis. Clin Microbiol Infect. 2017;23(4):234–41.CrossRefPubMed
15.
go back to reference Barrera CM, Mykietiuk A, Metev H, Nitu MF, Karimjee N, Doreski AP, et al. Efficacy and safety of oral solithromycin versus oral moxifloxacin for tratment of community acquired bacterial pneumonia: a global, double-blind, multicentre, randomized, active-controlled, non-inferiority trial (SOLITAIRE-ORAL). Lancet Infect Dis. 2016;16:421–30.CrossRefPubMed Barrera CM, Mykietiuk A, Metev H, Nitu MF, Karimjee N, Doreski AP, et al. Efficacy and safety of oral solithromycin versus oral moxifloxacin for tratment of community acquired bacterial pneumonia: a global, double-blind, multicentre, randomized, active-controlled, non-inferiority trial (SOLITAIRE-ORAL). Lancet Infect Dis. 2016;16:421–30.CrossRefPubMed
16.
go back to reference Chalmers JD, Taylor J, Singanayagam A, Fleming GB, Akram AR, Mandal GC, et al. Epidemiology, antibiotic therapy and clinical outcomes in health care associated pneumonia: a UK cohort study. Clin Infect Dis. 2011;53(2):107–13.CrossRefPubMed Chalmers JD, Taylor J, Singanayagam A, Fleming GB, Akram AR, Mandal GC, et al. Epidemiology, antibiotic therapy and clinical outcomes in health care associated pneumonia: a UK cohort study. Clin Infect Dis. 2011;53(2):107–13.CrossRefPubMed
17.
go back to reference Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Prediction of infection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia. Arch Intern Med. 2008;168:2205–10.CrossRefPubMed Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Prediction of infection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia. Arch Intern Med. 2008;168:2205–10.CrossRefPubMed
18.
go back to reference Aliberti S, Di Pasquale M, Zanaboni AM, Cosentini R, Brambilla AM, Seghezzi S, et al. Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Infect Dis. 2012;54:470–8.CrossRefPubMed Aliberti S, Di Pasquale M, Zanaboni AM, Cosentini R, Brambilla AM, Seghezzi S, et al. Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Infect Dis. 2012;54:470–8.CrossRefPubMed
19.
go back to reference Shindo Y, Ito R, Kobayashi D, Ando M, Ichikawa M, Shiraki A, et al. Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2013;188:985–95.CrossRefPubMed Shindo Y, Ito R, Kobayashi D, Ando M, Ichikawa M, Shiraki A, et al. Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2013;188:985–95.CrossRefPubMed
20.
go back to reference Ma HM, Ip M, Woo J, Hui DS. Development and validation of a clinical risk score for predicting drug-resistant bacterial pneumonia in older Chinese patients. Respirology. 2014;19:549–55.CrossRefPubMed Ma HM, Ip M, Woo J, Hui DS. Development and validation of a clinical risk score for predicting drug-resistant bacterial pneumonia in older Chinese patients. Respirology. 2014;19:549–55.CrossRefPubMed
21.
go back to reference Park SC, Kang YA, Park BH, Kim EY, Park MS, Kim YS, et al. Poor prediction of potentially drug-resistant pathogens using current criteria of health care-associated pneumonia. Respir Med. 2012;106:1311–9.CrossRefPubMed Park SC, Kang YA, Park BH, Kim EY, Park MS, Kim YS, et al. Poor prediction of potentially drug-resistant pathogens using current criteria of health care-associated pneumonia. Respir Med. 2012;106:1311–9.CrossRefPubMed
22.
go back to reference Sibila O, Laserna E, Maselli DJ, Fernandez JF, Mortensen EM, Anzueto A, et al. Risk factors and antibiotic therapy in P aeruginosa community acquired pneumonia. Respirology. 2015;20:660–6.CrossRefPubMed Sibila O, Laserna E, Maselli DJ, Fernandez JF, Mortensen EM, Anzueto A, et al. Risk factors and antibiotic therapy in P aeruginosa community acquired pneumonia. Respirology. 2015;20:660–6.CrossRefPubMed
23.
go back to reference Aliberti S, Cilloniz C, Chalmers JD, Zanaboni AM, Cosentini R, Tarsia P, et al. Multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia: a European perspective. Thorax. 2013;68:997–9.CrossRefPubMed Aliberti S, Cilloniz C, Chalmers JD, Zanaboni AM, Cosentini R, Tarsia P, et al. Multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia: a European perspective. Thorax. 2013;68:997–9.CrossRefPubMed
24.
go back to reference Aliberti S, Reyes LF, Faverio P, Sotgiu G, Dore S, Rodriguez AH, et al. Global initiative for methicillin-resistant Staphylococcus Aureus pneumonia (GLIMP): an international, observational cohort study. Lancet Infect Dis. 2016;16(12):1364–76.CrossRefPubMed Aliberti S, Reyes LF, Faverio P, Sotgiu G, Dore S, Rodriguez AH, et al. Global initiative for methicillin-resistant Staphylococcus Aureus pneumonia (GLIMP): an international, observational cohort study. Lancet Infect Dis. 2016;16(12):1364–76.CrossRefPubMed
25.
go back to reference Lee MTG, Lee SH, Chang SS, Chan YL, Pang L, Hsu SM, et al. Comparative treatment failure rates of respiratory fluoroquinolones or β-Lactam alone in the treatment for community acquired pneumonia in adult outpatients. Medicine. 2015;94(39):e1662.CrossRefPubMedPubMedCentral Lee MTG, Lee SH, Chang SS, Chan YL, Pang L, Hsu SM, et al. Comparative treatment failure rates of respiratory fluoroquinolones or β-Lactam alone in the treatment for community acquired pneumonia in adult outpatients. Medicine. 2015;94(39):e1662.CrossRefPubMedPubMedCentral
26.
go back to reference Frank E, Liu J, Kinasewitz G, Moran GJ, Oross MP, Olson WH, et al. A multicenter, open-label, randomized comparison of levofloxacin and ceftriaxone plus azithromycin in hospitalized adults with moderate to severe community-acquired pneumonia. Clin Ther. 2002;24:1292–308.CrossRefPubMed Frank E, Liu J, Kinasewitz G, Moran GJ, Oross MP, Olson WH, et al. A multicenter, open-label, randomized comparison of levofloxacin and ceftriaxone plus azithromycin in hospitalized adults with moderate to severe community-acquired pneumonia. Clin Ther. 2002;24:1292–308.CrossRefPubMed
27.
go back to reference Berger A, Edelsberg J, Oster G, Huang X, Pharm B, Weber D. Patterns if initial antibiotic therapy for community acquired pneumonia in US Hospitals, 2000 to 2009. Am J Med Sci. 2014;347(5):347–56.CrossRefPubMed Berger A, Edelsberg J, Oster G, Huang X, Pharm B, Weber D. Patterns if initial antibiotic therapy for community acquired pneumonia in US Hospitals, 2000 to 2009. Am J Med Sci. 2014;347(5):347–56.CrossRefPubMed
28.
go back to reference Pradelli J, Risso K, de Salvador FG, Cua E, Ruimy R, Roger PM. Community acquired pneumonia: impact of empirical antibiotic therapy without respiratory fluoroquinolones nor third-generation cephalosporins. Eur J Clin Microbiol Infect Dis. 2015;34:511–8.CrossRefPubMed Pradelli J, Risso K, de Salvador FG, Cua E, Ruimy R, Roger PM. Community acquired pneumonia: impact of empirical antibiotic therapy without respiratory fluoroquinolones nor third-generation cephalosporins. Eur J Clin Microbiol Infect Dis. 2015;34:511–8.CrossRefPubMed
29.
go back to reference Lim WS, Rodrogo C, Turner A, Welham S, Calvert JM. British Thoracic Society community acquired pneumonia care bundle: results of a national implementation project. Thorax. 2016;71:288–90.CrossRefPubMed Lim WS, Rodrogo C, Turner A, Welham S, Calvert JM. British Thoracic Society community acquired pneumonia care bundle: results of a national implementation project. Thorax. 2016;71:288–90.CrossRefPubMed
30.
go back to reference Shehabi Y, Sterba M, Garrett PM, Rachakonda KS, Stephens D, Harrigan P, et al. Procalcitonin algorithm in critically ill adults with undifferentiated or suspected sepsis infection: a randomized controlled trial. Am J Respir Crit Care Med. 2014;190(10):1102–10.CrossRefPubMed Shehabi Y, Sterba M, Garrett PM, Rachakonda KS, Stephens D, Harrigan P, et al. Procalcitonin algorithm in critically ill adults with undifferentiated or suspected sepsis infection: a randomized controlled trial. Am J Respir Crit Care Med. 2014;190(10):1102–10.CrossRefPubMed
31.
go back to reference Thomas Z, Bandali F, Sankaranarayanan J, Reardon T, Olsen KM. A multicenter evaluation of prolonged empiric antibiotic therapy in adult ICUs in the United States. Crit Care Med. 2015;43:2527–34.CrossRefPubMed Thomas Z, Bandali F, Sankaranarayanan J, Reardon T, Olsen KM. A multicenter evaluation of prolonged empiric antibiotic therapy in adult ICUs in the United States. Crit Care Med. 2015;43:2527–34.CrossRefPubMed
32.
go back to reference Uranga A, Espana PP, Bilbao A, Quintana JM, Arriaga I, Intxausti M, et al. Duration of antibiotic treatment in community acquired pneumonia: a multicenter randomized clinical trial. JAMA Intern Med. 2016;76(9):1257–65.CrossRef Uranga A, Espana PP, Bilbao A, Quintana JM, Arriaga I, Intxausti M, et al. Duration of antibiotic treatment in community acquired pneumonia: a multicenter randomized clinical trial. JAMA Intern Med. 2016;76(9):1257–65.CrossRef
33.
go back to reference Aliberti S, Ramirez J, Giuliani F, Wiemken T, Sotgiu G, Tedeschi S, et al. Individualizing duration of antibiotic therapy in community-acquired pneumonia. Pulm Pharmacol Ther. 2017;45:191–201.CrossRefPubMed Aliberti S, Ramirez J, Giuliani F, Wiemken T, Sotgiu G, Tedeschi S, et al. Individualizing duration of antibiotic therapy in community-acquired pneumonia. Pulm Pharmacol Ther. 2017;45:191–201.CrossRefPubMed
34.
go back to reference Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122:262–8.CrossRefPubMed Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122:262–8.CrossRefPubMed
35.
go back to reference Shindo Y, Ito R, Kobayashi D, Ando M, Ichikawa M, Goto Y, et al. Risk factors for 30 day mortality in patients with pneumonia who receive appropriate initial antibiotic: an observational cohort study. Lancet Infect Dis. 2015;15:1055–65.CrossRefPubMed Shindo Y, Ito R, Kobayashi D, Ando M, Ichikawa M, Goto Y, et al. Risk factors for 30 day mortality in patients with pneumonia who receive appropriate initial antibiotic: an observational cohort study. Lancet Infect Dis. 2015;15:1055–65.CrossRefPubMed
36.
go back to reference Self WH, Grijalva CG, Williams DJ, Woodworth A, Balk RA, Fakhran S, et al. Procalcitonin as an early marker of the need for invasive respiratory or Vasopressor support in adults with community-acquired pneumonia. Chest. 2016;150(4):819–28.CrossRefPubMed Self WH, Grijalva CG, Williams DJ, Woodworth A, Balk RA, Fakhran S, et al. Procalcitonin as an early marker of the need for invasive respiratory or Vasopressor support in adults with community-acquired pneumonia. Chest. 2016;150(4):819–28.CrossRefPubMed
37.
go back to reference Brambilla AM, Aliberti S, Prina E, Nicoli F, Del Forno M, Nava S, et al. Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure two to pneumonia. Intensive Care Med. 2014;40:942–9.CrossRefPubMed Brambilla AM, Aliberti S, Prina E, Nicoli F, Del Forno M, Nava S, et al. Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure two to pneumonia. Intensive Care Med. 2014;40:942–9.CrossRefPubMed
38.
go back to reference Carrillo A, Diaz-Gonzalez G, Ferrer M, Martinez-Quintana ME. Lopez -Martinez A, Llamas N, et al. Not invasive ventilation in community acquired pneumonia and severe acute respiratory failure. Intensive Care Med. 2012;38:458–66.PubMed Carrillo A, Diaz-Gonzalez G, Ferrer M, Martinez-Quintana ME. Lopez -Martinez A, Llamas N, et al. Not invasive ventilation in community acquired pneumonia and severe acute respiratory failure. Intensive Care Med. 2012;38:458–66.PubMed
39.
go back to reference Frat JP, Thille A, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal Cannula in hypoxemic acute respiratory failure. N Engl J Med. 2015;372:2185–96.CrossRefPubMed Frat JP, Thille A, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal Cannula in hypoxemic acute respiratory failure. N Engl J Med. 2015;372:2185–96.CrossRefPubMed
40.
go back to reference Roca O, Messika J, Caral B. Garcia de Acilu M, Sztrymf B, Ricard JD, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the RX index. J Crit Care. 2016;35:200–5. Roca O, Messika J, Caral B. Garcia de Acilu M, Sztrymf B, Ricard JD, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the RX index. J Crit Care. 2016;35:200–5.
41.
go back to reference Saiman L, Marshall BC, Mayer-Hamblett N, Burns JL, Quittner AL, Cibene DA, et al. Azithromycin in patients with cystic fibrosis chronically infected with Pseudomonas Aeruginosa: a randomized controlled trial. JAMA. 2003;290(13):1749–56.CrossRefPubMed Saiman L, Marshall BC, Mayer-Hamblett N, Burns JL, Quittner AL, Cibene DA, et al. Azithromycin in patients with cystic fibrosis chronically infected with Pseudomonas Aeruginosa: a randomized controlled trial. JAMA. 2003;290(13):1749–56.CrossRefPubMed
42.
go back to reference Wong C, Jayaram L, Karalus N, Eaton T, Tong C, Hockey H, et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomized, double blind, placebo-controlled trial. Lancet. 2012;18:380(9842):660–7.CrossRefPubMed Wong C, Jayaram L, Karalus N, Eaton T, Tong C, Hockey H, et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomized, double blind, placebo-controlled trial. Lancet. 2012;18:380(9842):660–7.CrossRefPubMed
43.
go back to reference Laserna E, Sibila O, Fernandez JF, Maselli DJ, Mortensen EM, Anzueto A, et al. Impact of macrolide therapy in hospitalized patients with community acquired pneumonia Pseudomonas Aeruginosa. Chest. 2014;145(5):1114–20.CrossRefPubMedPubMedCentral Laserna E, Sibila O, Fernandez JF, Maselli DJ, Mortensen EM, Anzueto A, et al. Impact of macrolide therapy in hospitalized patients with community acquired pneumonia Pseudomonas Aeruginosa. Chest. 2014;145(5):1114–20.CrossRefPubMedPubMedCentral
44.
45.
go back to reference Tagami T, Matsui H. FushimiK, Yasunaga H. Intravenous immunoglobulin pneumonia and mortality in patients with septic shock: an observational study nationwide. Clin Infect Dis. 2015;61(3):385–92.CrossRefPubMed Tagami T, Matsui H. FushimiK, Yasunaga H. Intravenous immunoglobulin pneumonia and mortality in patients with septic shock: an observational study nationwide. Clin Infect Dis. 2015;61(3):385–92.CrossRefPubMed
46.
go back to reference Janda S, Young A, Fitzgerald JM, Etminan M, Swiston J. The effect of statins on mortality from severe infections and sepsis: a systematic review and meta-analysis. J Crit Care. 2010;25(656):e7–E622. Janda S, Young A, Fitzgerald JM, Etminan M, Swiston J. The effect of statins on mortality from severe infections and sepsis: a systematic review and meta-analysis. J Crit Care. 2010;25(656):e7–E622.
47.
go back to reference Greenwood H, Patel J, Mahida R, Wang Q, Parekh D, Dancer RCA, et al. Simvastatin to modify neutrophil function in older patients with septic pneumonia (SNOOpi): study protocol for a randomized placebo-controlled trial. Trials. 2014;15:332.CrossRefPubMedPubMedCentral Greenwood H, Patel J, Mahida R, Wang Q, Parekh D, Dancer RCA, et al. Simvastatin to modify neutrophil function in older patients with septic pneumonia (SNOOpi): study protocol for a randomized placebo-controlled trial. Trials. 2014;15:332.CrossRefPubMedPubMedCentral
48.
go back to reference Siemieniuk RAC, Meade M, Alonso-Coello P, Briel M, Evaniew N, Prasad M, et al. Corticosteroid therapy for patients hospitalized with community acquired pneumonia. A systematic review and meta-analysis. Ann Intern Med. 2015;163(7):519–28. Siemieniuk RAC, Meade M, Alonso-Coello P, Briel M, Evaniew N, Prasad M, et al. Corticosteroid therapy for patients hospitalized with community acquired pneumonia. A systematic review and meta-analysis. Ann Intern Med. 2015;163(7):519–28.
49.
go back to reference Wirz SA, Blum CA, Schuetz P, Albrich WC, Noppen C, Mueller B, et al. Pathogen-specific effects of prednisone and antibiotic in community acquired pneumonia. Eur Respir J. 2016;48:1150–9.CrossRefPubMed Wirz SA, Blum CA, Schuetz P, Albrich WC, Noppen C, Mueller B, et al. Pathogen-specific effects of prednisone and antibiotic in community acquired pneumonia. Eur Respir J. 2016;48:1150–9.CrossRefPubMed
50.
go back to reference Chalmers JD. Corticosteroids for community acquired pneumonia: a critical view of the evidence. Eur Respir J. 2016;48:984–6.CrossRefPubMed Chalmers JD. Corticosteroids for community acquired pneumonia: a critical view of the evidence. Eur Respir J. 2016;48:984–6.CrossRefPubMed
52.
go back to reference Carta S, Silvestri M, Rossi GA. Modulation of airway epithelial cell functions by Pidotimod: NF-kB cytoplasmatic expression and its nuclear translocation are associated with an increased TLR-2 expression. Ital J Pediatr. 2013;39:29–38.CrossRefPubMedPubMedCentral Carta S, Silvestri M, Rossi GA. Modulation of airway epithelial cell functions by Pidotimod: NF-kB cytoplasmatic expression and its nuclear translocation are associated with an increased TLR-2 expression. Ital J Pediatr. 2013;39:29–38.CrossRefPubMedPubMedCentral
53.
go back to reference Esposito S, Garziano M, Rainone V, Trabattoni D, Biasin M, Senatore L, et al. Immunomodulatory activity of pidotimod administered with standard antibiotic therapy in children hospitalized for community-acquired pneumonia. J Transl Med. 2015;13:288–98.CrossRefPubMedPubMedCentral Esposito S, Garziano M, Rainone V, Trabattoni D, Biasin M, Senatore L, et al. Immunomodulatory activity of pidotimod administered with standard antibiotic therapy in children hospitalized for community-acquired pneumonia. J Transl Med. 2015;13:288–98.CrossRefPubMedPubMedCentral
54.
go back to reference Zuccotti GV, Mameli C, Trabattoni D, Beretta S, Biasin M, Guazzarotti L, et al. Immunomodulating activity of Pidotimod in children with Down syndrome. J Biol Regul Homeost Agents. 2013;27:253–8.PubMed Zuccotti GV, Mameli C, Trabattoni D, Beretta S, Biasin M, Guazzarotti L, et al. Immunomodulating activity of Pidotimod in children with Down syndrome. J Biol Regul Homeost Agents. 2013;27:253–8.PubMed
55.
go back to reference Trabattoni D, Clerici M, Centanni S, Mantero M, Garziano M, Blasi F. Immunomodulatory effects of pidotimod in adults with community acquired pneumonia undergoing standard antibiotic therapy. Pulm Pharmacol Ther. 2017;44:24e29.CrossRef Trabattoni D, Clerici M, Centanni S, Mantero M, Garziano M, Blasi F. Immunomodulatory effects of pidotimod in adults with community acquired pneumonia undergoing standard antibiotic therapy. Pulm Pharmacol Ther. 2017;44:24e29.CrossRef
Metadata
Title
Antibiotic therapy, supportive treatment and management of immunomodulation-inflammation response in community acquired pneumonia: review of recommendations
Authors
Marco Mantero
Paolo Tarsia
Andrea Gramegna
Sonia Henchi
Nicolò Vanoni
Marta Di Pasquale
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Multidisciplinary Respiratory Medicine / Issue 1/2017
Electronic ISSN: 2049-6958
DOI
https://doi.org/10.1186/s40248-017-0106-3

Keynote webinar | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the broader systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on adolescent vaping

  • Live
  • Webinar | 29-01-2025 | 18:00 (CET)

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Watch it live: Wednesday 29th January, 18:00-19:30 CET
 

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Join the webinar

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more