Table 3.
Overview of recommendations from all examined guidelines
| Potential pathogen | ATS
|
BSAC
|
CCCTG | G-HAP
|
PEG
|
|---|---|---|---|---|---|
| Early onset, no MDR risk, any disease severity | Early onset, no MDR risk, no other risk factors | No MDR risk | CPR score 0–2 | ||
|
Streptococcus pneumoniae Haemophilus influenzae Staphylococcus aureus Enteric gramnegative bacilli: Escherichia coli Klebsiella pneumoniae Enterobacter sp. Proteus sp. Serratia marcescens |
Ceftriaxone (3rd gen cephalosporin) or Levofloxacin, moxifloxacin or Ciprofloxacin (fluoroquinolone) or Ampicillin/sulbactam (aminopenicillin/BLI) or Ertapenem (carbapenem) |
Amoxicillin/clavulanic acid (aminopenicillin/BLI) or Cefuroxime (2nd gen cephalosporin) Early-onset, MDR risk and/or other risk factors Cefotaxime or ceftriaxone (3rd gen cephalosporin) or Fluoroquinolone or Piperacillin/tazobactam (acylaminopenicillin/BLI) |
Depends on locale spectrum of pathogens and susceptibility | 4th gen cephalosporin or Aminopenicillin/BLI or Ertapenem or Fluoroquinolone |
Ceftriaxone, cefotaxime (3rd gen cephalosporin) or Levofloxacin or Moxifloxacin (fluoroquinolone) or Ampicillin/sulbactam, amoxicillin/clavulanic acid (aminopenicillin/BLI) or Ertapenem (carbapenem) |
| Late onset or MDR risk, any disease severity | Late onset | MDR risk | CPR score 3–5 | ||
| Above and MDR pathogens: Pseudomonas aeruginosa Klebsiella pneumoniae (ESBL) Acinetobacter sp. |
Cefepime, ceftazidime (4th/3rd gen cephalosporin) or Imipenem, meropenem (carbapenem) or Piperacillin/tazobactam (acylaminopenicillin/BLI) plus Ciprofloxacin, levofloxacin (fluoroquinolone) or Amikacin, gentamicin or tobramycin (aminoglycoside) |
Depends on locale spectrum of pathogens and susceptibility | Piperacillin/tazobactam or Imipenem, meropenem or 4th gen cephalosporin plus Aminoglycoside or Fluoroquinolone |
Cefepime (4th gen cephalosporin) or Doripenem, imipenem, meropenem (carbapenem) or Piperacillin/tazobactam (acylaminopenicillin/BLI) CPR score 6 and more Treatment for CPR 3–5 plus Ciprofloxacin, levofloxacin (fluoroquinolone) or Amikacin, gentamicin or tobramycin (aminoglycoside) or Fosfomycin |
|
| Methicillin-resistant | Plus | Linezolid, vancomycin | Linezolid, vancomycin | Linezolid, vancomycin | |
| Staphylococcus aureus (MRSA) | Linezolid, vancomycin | ||||
| Legionella pneumophila | Macrolide or fluoroquinolone instead of aminoglycoside | – | – | Macrolide or fluoroquinolone | |
Abbreviations: ATS, American Thoracic Society; BLI, beta-lactamase inhibitor; BSAC, British Society for Antimicrobial Chemotherapy; CCCTG, Canadian Critical Care Trials Group; CPR, clinical patient risk score; G-HAP, S3-Guideline for hospital-acquired pneumonia in Germany; gen, generation; MDR, multidrug resistance; PEG, Paul-Ehrlich-Gesellschaft; ESBL, extended-spectrum beta-lactamase.