[Empiric therapy of community-acquired pneumonia: a transatlantic controversy]

Abstract

North American and European guidelines for empiric antimicrobial therapy of community-acquired pneumonia differ. This stems from a different mechanism of pneumococcal resistance to macrolides, and a different perception of the need to cover atypical germs. For mild cases, two recent meta-analyses conclude that this coverage is not associated with any benefit. For more severe pneumonias, data are scarce and experts generally recommend wide coverage. Except for particular situations, the new fluoroquinolones should not represent the first-line therapy because of rapidly growing resistance to these antibiotics.