Generally speaking, the causes of pneumonia can be classified in two ways: where it was. She has no history of significant respiratory illness aside from a mild upper respiratory infection several years before, which was successfully treated with oral antibiotics. Bronchiolitis obliterans: Should be suspected in patients with pneumonia who do not respond to antibiotics treatment. Ebell M.H. The levels of procalcitonin -- a protein expressed by the C cells in the thyroid gland and by neuroendocrine cells in the lungs and intestines -- are normally undetectable. Gram stain showing Moraxella catarrhalis. The alphabet soup of pneumonia: CAP, HAP, HCAP, NHAP, and VAP. Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A (H1N1) - United States, May-August 2009. 285(21):2763-73. Causes of childhood pneumonia (>5years old). Pneumonia 2014;3:95. 63(37):822-5. The chest radiograph shows bilateral opacities with a predominantly peripheral distribution. Previously, it was recommended that septic patients who were hypotensive despite fluid resuscitation and vasopressor support be screened for occult adrenal insufficiency. Available at http://bit.ly/i3ATH5. Suctioning and bronchial hygiene Pulmonary toilet may include active suction of secretions, chest physiotherapy, positioning to promote dependent drainage, and incentive spirometry to enhance elimination of purulent sputum and to avoid atelectasis. For the next 48 hours, she receives oxygen by high-flow nasal cannula (HFNC) as well as vancomycin, ceftriaxone, and azithromycin. Pathogen-Driven Antibiotic Choices. Forgie S, Marrie TJ. Justina Gamache, MD Resident Physician, Department of Internal Medicine, Olive View-UCLA Medical CenterDisclosure: Nothing to disclose. In this review, we will use the term "nonresolving pneumonia" to include those cases of presumed pneumonia that progress, resolve slowly, or fail to achieve complete resolution despite what is thought to be appropriate therapy. Phillips D. ACIP changes pneumococcal vaccine interval in low-risk elderly. The Washington manual of outpatient internal medicine. Treatment in an ICU setting with the following: >10% of gram-negative isolates are resistant to one or more antibiotics indicated for VAP, Local antimicrobial susceptibilities are unknown. Treatment in a medical ward/ICU in which: Antipseudomonal cephalosporins (eg, Cefepime, ceftazidime), Antipseudomonal carbapenems (imipenem or meropenem), Beta-lactam/beta-lactamase inhibitors (piperacillin-tazobactam) with an antipseudomonal fluoroquinolone (ciprofloxacin) or aminoglycoside plus linezolid or vancomycin (if MRSA risk factors are present), Telavancin is indicated for VAP for susceptible isolates of, Infants younger than 3 to 6months with suspected bacterial CAP, Suspected or documented CAP caused by a pathogen with increased virulence, such as community-associated methicillin-resistant, Temperature greater or equal to 38.5C (101.3F), Children and infants for whom there is concern about careful observation at home or who are unable to comply with therapy or unable to be followed-up, Children and infants who have respiratory distress and hypoxemia (oxygen saturation<92%) (see, Children and infants with comorbidities (eg, asthma, cystic fibrosis, congenital heart disease, diabetes mellitus, neuromuscular disease), Age 0 to 2months: greater than 60; age 2 to 12months: greater than 50; age 1 to 5years: greater than 40; age greater than 5years: greater than 20, Retractions: suprasternal, intercostal, or subcostal, Pulse oximetry measurement less than 90% on room air, Pneumonia, Ventilator-associated, Community-acquired, Pediatric, Antibiotic resistance, Microbial pathogens. Kalil AC, Murthy MH, Hermsen ED, Neto FK, Sun J, Rupp ME. Radiographic images in a patient with bilateral lower lobe pneumonia. Most viral pneumonias don't have a specific treatment and just get better on their own. Acute lower respiratory tract infection. Antibiotic therapy is the mainstay of treatment of bacterial pneumonia. Selection of antibiotics is typically done empirically and based on whether the patient has any risk factors for MDR pathogens (Table7 First-line and preferred agent is still amoxicillin.50, 54, 57, 59 Alternative agents are cephalosporins and macrolide antibiotics; however, increasing resistance to penicillin derivatives and macrolides should be noted60 (Table10 [QxMD MEDLINE Link]. The pneumococcal 23-valent vaccine is approved for adults aged 50 years or older and persons aged two years or older who are at increased risk for pneumococcal disease. Med Clin North Am. Semin Respir Crit Care Med. Choosing an antibiotic for CP is initially always an empirical process and based on local and regional microbial susceptibility and resistance patterns, along with thechilds age, immunization status, and any underlying, preexisting health conditions.50, 54, 58, 59 Most children can be treated with oral antibiotics in the outpatient setting. Opportunistic pathogens (eg, Fungi, mold, Misdiagnosis (fungal infections, sarcoidosis, TB), Chlamydia pneumoniae/Chlamydia trachomatis, Amoxicillin-clavulanate/third-generation cephalosporin, Third-generation cephalosporin/clindamycin, Quinolone if older than 8years and suspect MDR organism, IV penicillin derivative and third-generation cephalosporin, Aminoglycoside with PCN derivative; macrolide if suspect atypical organism, IV penicillin derivative (PCN or ampicillin), Vancomycin or clindamycin (in addition to beta-lactam antibiotic), Macrolide (in addition to beta-lactam antibiotic), Vancomycin or clindamycin (in addition to beta-lactam antibiotic); linezolid in children aged 12y or older, Third-generation cephalosporin and macrolide/vancomycin+ third-gen ceph+macrolide, Third-generation cephalosporin and doxycycline/vancomycin+ third-gen ceph+macrolide+(optional) Nafcillin+antiviral. In: Mayhall C., editor. 2001 Nov. 85(6):1381-96. Semin Respir Crit Care Med. OP is associated with many . In: Schwartz E., editor. Vaccines for preventing pneumococcal infection in adults. H1N1 Flu: Updated CDC estimates of 2009 H1N1 influenza cases, hospitalizations and deaths in the United States April 2009 - April 10, 2010. [Full Text]. Specifications manual for national hospital inpatient quality measures. N Engl J Med. Pneumonia severity index calculator. The timing of radiologic resolution of pneumococcal pneumonia varies with patient age, the severity of the pneumonia, and the presence or absence of an underlying lung disease. Bafadhel M, Clark TW, Reid C, Medina MJ, Batham S, Barer MR, et al. JAMA. Emerg Infect Dis. 2009 Feb. 30(1):61-6. 1999 Jul 26. Additional testing for M.tuberculosis should be considered in a patient presenting with persistent cough, particularly in the setting of weight loss, malaise, night sweats, or hemoptysis. Pneumonia: Symptoms, Causes, Treatment, and More - Healthline Elderly patients with pneumonia may not exhibit typical symptoms or physical examination findings seen in younger adults, such as pleuritic chest pain, cough, fever, and leukocytosis.32 Signs and symptoms more frequently seen in older adults include falls, decreased appetite, or functional impairment.32 A change in mental status should prompt evaluation for an infectious cause.9, 11 As with any adult, risk factors for atypical or drug-resistant pathogens should guide treatment. Skerrett SJ. She says she is a smoker who returned to the habit about 8 months previously after several years of abstaining from tobacco. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Atypical organisms may be involved when children are immunocompromised or have other underlying comorbidities (see Table9). 2015 Oct 6. The committee recommends routine use of Prevnar 13 in addition to the previously recommended Pneumovax 23 for adults aged 19 years and older with immunocompromising conditions (eg, HIV, cancer, renal disease), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants. [Guideline] Dellinger RP, Levy MM, Carlet JM, et al. In patients who have previously received Pneumovax 23 vaccine, administer one dose of Prevnar 13 at least one year after the last Pneumovax 23 dose. Home Remedies and Lifestyle Most cases of pneumonia can be treated at home with the following measures: Get as much rest as possible. Empirical antibiotic therapy for ventilator-associated pneumonia. [QxMD MEDLINE Link]. Her rapid improvement after initiating treatment with corticosteroids is a hallmark of AEP. Plan Health News Antibiotics Surprisingly Ineffective on Pneumonia Researchers say as many as 1 in 4 patients will not be cured by an initial prescription. [Full Text]. The role of gram-negative bacteria in healthcare-associated pneumonia. Clin Microbiol Rev. Adjustments on the treatment of cancer patients with pneumonia The chest radiograph reveals a left lower lobe opacity with pleural effusion. The Pneumonia Severity Index (PSI) considers 20 variables to stratify patients into 1 of 5 risk categories (IV) based on risk of death within 30days.15 Given the number of parameters required, it is not frequently used in general practice. Peleg AY, Hooper DC. 2009 Feb. 30(1):67-85. Kollef MH, Ricard JD, Roux D, et al. Table. [3, 17] : Clindamycin or metronidazole plus a respiratory fluoroquinolone plus ceftriaxone, For suspected infection with methicillin-resistant S aureus (MRSA), vancomycin or linezolid may be added to the antibiotic regimen until the organism's identity and antibiotic sensitivities are known, at which point the medications can be adjusted accordingly. Pneumonia is a leading cause of hospitalization among both adults and children in the United States, accounting for more than 800,000 hospitalizations and more than 400,000 emergency department visits in 2014.1, 2 It is among the most expensive conditions treated in US hospitals with national aggregate costs of $9.5 billion in 2013. Patients with comorbidities such as diabetes; chronic heart, lung, renal, or liver disease; alcoholism; asplenia; impaired immune system; or recent antibiotic use within the last 3months have an increased risk for drug-resistant S pneumoniae. A prompt diagnosis is important, since treatment of AEP differs from that of bacterial pneumonia, and left untreated, patients may experience a precipitous decline or even death. Elderly patients with history of stroke or known dysphagia are at an increased risk for aspiration pneumonia. Staphylococcus aureus and Enterobacteriaceae were significantly more common among patients requiring intensive care unit (ICU) level care.4 Other bacteria identified in CAP include Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Haemophilus influenzae.5 Less common bacterial causes include Mycobacterium tuberculosis, Legionella sp, and Pseudomonas aeruginosa. The ACIP currently recommends that a dose of PCV13 be followed by a dose of PPSV23 in persons aged 2 years or older who are at high risk for pneumococcal disease because of underlying medical conditions. Isolation of the particular microbial organism is ideal, but not required, in order to determine duration of therapy. When you get pneumonia -- whether it was caused by bacteria, a virus, or a fungus -- there's a chance it could . 177-80. [QxMD MEDLINE Link]. Validation of the Infectious Disease Society of America/American Thoracic Society 2007 guidelines for severe community-acquired pneumonia. Over the course of the next 24 hours, she is gradually weaned off supplemental oxygen completely. Chest radiograph in a patient with HIV infection, bilateral perihilar infiltrates, and Pneumocystis jiroveci pericarditis. 171(13):1193-8. Treatment for pneumonia depends on the type of pneumonia, how sick the patient is, the patient's age, and if other underlying medical . Available at http://www.medscape.com/viewarticle/850564. 2008 Aug 1. However, this evidence was rated moderate as the confidence interval crossed 1 and because of a possible subgroup effect. 2008 Jan. 34(1):17-60. Pneumonia is a type of lung infection that causes cough, fever, and difficulty breathing. Sialer S., Liapikou A., Torres A. Predicting pneumonia in adults with respiratory illness. Pneumonia caused by bacterial infection, however, can make a person very sick. [QxMD MEDLINE Link]. Swanson J.M., Wells D.L. American Lung Association. 2005 Jun 1. Introduction. According to the 2009 Centers for Medicare and Medicaid Services (CMS) and Joint Commission consensus guidelines, inpatient treatment of pneumonia should be given within four hours of hospital admission (or in the emergency department if this is where the patient initially presented) and should consist of the following antibiotic regimens, [QxMD MEDLINE Link]. No individual component of the history or physical examination is useful in diagnosing pneumonia, but the presence of multiple findings is required (Table2 6 Serious Complications of Pneumonia You Should Know Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Anand N, Kollef MH. Resistance to Levofloxacin and Failure of Treatment of Pneumococcal [QxMD MEDLINE Link]. Patients in respiratory failure or those with COPD who need high oxygen concentrations may require endotracheal intubation and ventilation. Trends in pneumonia and influenza morbidity and mortality. Most cases of pneumonia can be managed in the outpatient setting. ). In contrast, resolution may be delayed for 12 weeks or longer in older individuals and those with underlying lung disease. McCullers JA. Med Clin North Am. 107(1A):34S-43S. JAMA. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzAwMTU3LXRyZWF0bWVudA==. High-resolution CT of the lung: patterns of disease and differential diagnoses. Ventilator-associated pneumonia (VAP) is a type of pneumonia that occurs in patients who have been intubated or mechanically ventilated by means of a tracheostomy for at least 48hours.37, 38 Mechanical ventilation modifies the oropharyngeal and tracheal environment, allowing oral and gastric secretions to enter the lower airways.37 It is this change in lower respiratory tract bacterial flora that precipitates the beginning of pneumonia. 345(19):1368-77. In previously healthy patients with no exposure to antibiotics within the previous 90 days, use a macrolide or doxycycline (weak recommendation). You are being redirected to How Is Pneumonia Treated? In a meta-analysis of 29 studies of antibiotic treatment for pneumonia in children, 14 studies reported that bacterial pathogens could be isolated in only 12% of participants; S. pneumoniae and H . Chest. WebMD Inc. Sept 4, 2015. Clinicians immediately discontinue treatment with antibiotics and initiate 125 mg of intravenous methylprednisolone every 12 hours. The results of tests performed at the community hospital -- including a respiratory viral polymerase chain reaction pathogen panel, urinary streptococcal and Legionella antigens, sputum culture, and blood cultures -- are all negative. Go to Community-Acquired Pneumonia for complete information on this topic. Available at http://bit.ly/gwYJAE. Pneumonia - Diagnosis and treatment - Mayo Clinic Abbreviations: AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus; MRSA, methicillin-resistant staphylococcus aureus. Early versus late-onset VAP organisms have also been documented.46, 47 Acinetobacter, citrobacter, pseudomonas, and klebsiella are the most predominant late-onset organisms, warranting more aggressive antibacterial intervention.47, Bacterial distribution in ventilator-associated pneumonia, Bacterial confirmation usually requires secretion sampling, either via bronchoscopic or via nonbronchoscopic methods. Margolis P., Gadomski A. Please confirm that you would like to log out of Medscape. Both Hodgkin and non-Hodgkin lymphoma can present with lung involvement, with typical radiographic findings of hilar or mediastinal adenopathy, but may also have a presenting pattern that suggests infection.31. September 2008. Pediatric emergencies associated with fever. Antibiotic therapy is the mainstay of treatment of bacterial pneumonia. 2009 Dec. 37(12):3010-6. Chest pain when you breathe or cough. 2001 Nov. 85(6):1461-91, x. [74], On August 13, 2014, the CDCs Advisory Committee on Immunization Practices (ACIP) recommended routine use of pneumococcal vaccine 13-valent (PCV13 [Prevnar 13]) among adults aged 65 years and older. [QxMD MEDLINE Link]. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. Crit Care Med. Important components of a history include recent travel, history of underlying lung disease, and smoking history.4, 6 A study by Diehr and colleagues7 found that history of alcoholism or bloody sputum have relative risk of 1, so the presence of these findings is not predictive of pneumonia. 163 (7):519-28. Pneumonia Treatment and Recovery | American Lung Association Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: a systematic review and meta-analysis. N Engl J Med. 374(9700):1543-56. Radiol Clin North Am. The American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) recently updated their recommendations on the diagnosis and treatment of community-acquired pneumonia (CAP . Absence of any vital sign abnormality (blood pressure, heart rate, respiratory rate) reduces the predicted probability of pneumonia to 1%.8 A chest radiograph should be ordered for any patient with abnormal vital signs defined as temperature higher than 100F, heart rate higher than 100bpm, or respiratory rate higher than 20bpm. Hand washing between patient contacts is a basic and often neglected behavior by medical personnel. Nasal CPAP is not usually as well tolerated as a full mask (which covers both the nose and mouth) in the emergent situation. Kaysin A., Viera A.J. ).11, Outpatient treatment of community-acquired pneumonia. [Full Text]. Pathogen-host interactions in Pseudomonas aeruginosa pneumonia. Opens in a new tab or window, Visit us on LinkedIn. Trimble A., Moffat V., Collins A. Community-acquired pneumonia requiring hospitalization among U.S. adults. [QxMD MEDLINE Link]. Sadikot RT, Blackwell TS, Christman JW, Prince AS. Day 5. The Management of Community-Acquired Pneumonia in Infants and Children Computed tomography (CT) scanning may be helpful in unclear cases and in delineating more complex pulmonary processes. [QxMD MEDLINE Link]. Chest radiograph shows multifocal, patchy consolidation in the right upper, middle, and lower lobes. [QxMD MEDLINE Link]. Pneumonia in children: inpatient treatment. Other initial treatments may include correction of electrolyte levels and chest physiotherapy (to assist in drainage of secretions). Muscedere J.G., Shorr A.F., Jiang X. 336(4):243-50. Thus, in immunocompetent patients hospitalized with severe CAP, systemic corticosteroids should be considered given the possible mortality benefit of systemic corticosteroid treatment in this subgroup of patients. Nursing home-acquired pneumonia. Less common bacterial organisms may infect newborns (see Table8). Can you have pneumonia without a cough? Other symptoms and more 2006 Dec 1. Feldman C., Anderson R. Corticosteroids in the adjunctive therapy of community-acquired pneumonia: an appraisal of recent meta-analyses of clinical trials. ). Carefully review the patient's medical history, especially in regard to potential inhaled respiratory exposure. Hospital-acquired infections due to gram-negative bacteria. Pneumocystis jiroveci pneumonia (PJP), formerly known as Pneumocystis carinii pneumonia (PCP), is the most common opportunistic infection in persons with HIV infection. van der Poll T, Opal SM. 66(4):340-6. Manual download retrieved April 2009. Residents of nursing homes or long-term care facilities are at an increased risk for methicillin-resistant Staphylococcus aureus (MRSA) or multidrug-resistant (MDR) pathogens.32, Evaluation of a returned traveler should include the following: appropriate history covering the travel itinerary (location and activities), onset of illness related to travel, vaccines or prophylaxis received, diet, sexual history, and exposure to animals.30, 33 Respiratory tract infections are among the most common health care complaints affecting returned travelers and are diagnosed in up to 24% of returned patients with fever.30, 34 Although upper respiratory tract infections are more common, the severity and possible mortality associated with lower respiratory tract infections such as pneumonia make it a must-not-miss diagnosis in the returned traveler. Fang WF, Yang KY, Wu CL, Yu CJ, Chen CW, Tu CY, et al. N Engl J Med. 2009 Feb. 30(1):102-15. Pneumonia Treatment Options - Verywell Health Approximately 30% of patients who receive mechanical ventilation will develop VAP.39, VAP should be suspected when signs of pulmonary infection (fever, purulent secretions, leukocytosis) and radiologic evidence (air bronchograms, infiltrates) are present; bacteriologic confirmation usually follows.40 Sensitivity and specificity of the diagnostic criteria discussed earlier are 69% and 75%, respectively.40 Other useful diagnostic criteria have been developed, incorporating additional symptoms and similar signs and laboratory/radiologic criteria.41 Once VAP is clinically suspected, early empirical treatment is favored. Clinical acumen is key to successfully diagnosing CP. Medpage Today is among the federally registered trademarks of MedPage Today, LLC and may not be used by third parties without explicit permission. However, patients who have bronchospasm with infection benefit from inhaled bronchodilators, administered by means of a nebulizer metered-dose inhaler. A 2011 Cochrane review that included relevant CAP studies through the year 2010 showed that corticosteroid use accelerates time to symptom resolution and clinical stability, with infrequent adverse effects.19 Similarly, a 2015 systematic review by Siemieniuk and colleagues20 included studies from 2011 through mid-2015. 2003 May. Gram stain showing Streptococcus pneumoniae. The incidence of pneumococcal disease is the highest in children younger than two years and in adults older than 65 years. ). 2009 pandemic influenza A (H1N1) in pregnant women requiring intensive care - New York City, 2009. . 59(11):321-6. The patient should also be instructed to return promptly if their condition deteriorates. [Full Text]. Additional symptoms frequently seen include fatigue, anorexia, and pleuritic chest pain. 362(19):1804-13. Patients who are severely ill and those with signs of respiratory failure, sepsis, and/or neutropenia must be stabilized before transfer. [QxMD MEDLINE Link]. 358(7):716-27. Incidence, correlates, and chest radiographic yield of new lung cancer diagnosis in 3398 patients with pneumonia. 2011 Jul 11. Nevertheless, she subsequently deteriorated to the point of requiring mechanical ventilation, and antibiotics were discontinued. Sepsis is a serious, life-threatening condition with potentially fatal outcomes. Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, et al. Delaying treatment and/or not appropriately covering for the likely microbial culprit are both associated with higher morbidity and mortality.42, 43, 44, 45, Microbial organisms associated with VAP have been identified (Table6 Systemic support may include proper hydration, nutrition, and early mobilization to create a positive host milieu to fight infection and speed recovery. 2010 Oct 28. The information in this section is derived mainly from the current Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines for the management of CAP. Treatment for pneumonia depends on the type of pneumonia you have, how sick you are feeling, your age, and whether you have other health conditions. Obtaining pleural fluid, when present, under ultrasound guidance, is recommended.37 Endotracheal aspirates are easilyretrieved but have a high false-positive rate in ICU patients due to airway colonization.37 Bronchoscopic retrieval of distal airway specimens via BAL or protected-specimen brush techniques is the best, but requires a trained bronchoscopist.37. Almost all major decisions regarding management of pneumonia address the initial assessment of severity. Although guidelines have routinely recommended follow-up chest radiography in order to exclude underlying lung cancer, studies have found that the incidence of lung cancer following pneumonia is relatively low. The cough may be described as productive. Annie Harrington, MD Fellow in Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center Further testing depends on treatment venue (outpatient vs inpatient) and other specific criteria (see Table3). https://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/2011%20CAP%20in%20Children.pdf, file:///C:/Users/sgrief/Downloads/Community%20Acquired%20Pneumona%20Great%20001.pdf, https://www.hcup-us.ahrq.gov/reports/statbriefs/sb225-Inpatient-US-Stays-Trends.pdf, http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2014_ed_web_tables.pdf, http://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.pdf, http://jamaevidence.mhmedical.com.proxy.cc.uic.edu/content.aspx?bookid=845§ionid=61357585, https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html, https://wwwnc.cdc.gov/travel/yellowbook/2018/post-travel-evaluation/general-approach-to-the-returned-traveler, http://www.who.int/mediacentre/factsheets/fs331/en/index.html, http://www.aappublications.org/news/aapnewsmag/2016/10/31/Fluoroquinolones103116.full.pdf, https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/safety-reviews/summary-safety-review-fluoroquinolones-assessing-potential-risk-persistent-disabling-effects.html, Fluoroquinolone or beta-lactam+macrolide (doxycycline is an alternative for macrolide), Bronchiolitis obliterans/Bronchiectasis/Influenza B, Age>60/Aspiration/Anaerobic infection/Abscess/Influenza A/Atypical pathogens (eg, Legionella, Mycoplasma, hMPV, chlamydia). FDA requests boxed warnings on fluoroquinolone antimicrobial drugs: seeks to strengthen warnings concerning increased risk of tendinitis and tendon rupture [press release]. Knowledge of local bacterial pathogens and their antibiotic susceptibility and resistance profiles is the key for effective pharmacologic selection and treatment of pneumonia.
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