**Author details**

**3.5. Treatment of CAP**

44 Contemporary Topics of Pneumonia

than 80–90% relative to the initial value [65].

outcomes of patients such as climate changes.

**4. Conclusion**

Severity assessment is a prerequisite to an accurate decision for the place of care (ICU or not). Empirical antibiotic therapy is widely used in the treatment of CAP and should include pneumococcal coverage. The promptitude of the treatment (less than 8 h from diagnosis) has been shown to improve mortality rate. Few recommendations by the American Thoracic Society (ATS) emphasize the relevance of some conditions such as the severity of the pneumonia, the previous health status of the patient, the comorbidities, and a previous use of antibiotic therapy less than 3 months. The combination therapy or the monotherapy is regularly questioned, but evidence shows the superiority of the combination therapy in severe patients [57, 63, 64]. The use of pneumonia severity index and CURB 65 will help to improve the outcomes of CAP, by a relevant orientation of the patients. In ambulatory patients with mild to moderate disease, monotherapy, and mainly by oral route is a common practice. The empirical choice is the class of β-lactamases (amoxicillin) or macrolides in case of allergy to the former. Fluoroquinolones in monotherapy, even recommended in some developed countries such as the North America should be discouraged in the settings where TB is a great concern, because of the influence of these drugs on the delay of TB diagnosis and the lack of alternative diagnosis tools for smear-negative tuberculosis. Macrolides and doxycycline are suitable when mycoplasma or chlamydia are the suspected etiologic agents. A previous history of antibiotic therapy in the latter 3 months guides the choice for a not yet used antibiotic by the patient. This is to minimize the emergence of resistance to antibiotics. In hospitalized patients, a part from taking care of the comorbidities, monotherapy using amoxicillin-clavulanic acid may be a choice according to the severity of the illness; combination therapy of the latter with advanced macrolides (clarithromycin, azithromycin) is often recommended. In case of a risk of aspiration pneumonia (Dementia, Alzheimer, Diphtheria), the clindamycin should be added. Patients admitted in ICU need combination therapy as first choice and G3-cephalosporins; or carbapenems are regularly prescribed. The emergence of resistance is nevertheless a threat in these critically ill subjects. Adjunctive therapies in hospitalized patients include oxygen suppliance if necessary, low doses corticosteroids in suspected adrenal insufficiency following the bacteremia phase may be added to improve outcomes. Nonsevere CAP could be treated ambulatory with a 7-day monotherapy with oral antibiotics. The use of pneumonia severity index and CURB 65 or serum biomarkers may improve the prognosis of the illness. Among the biomarkers, the procalcitonin has been assessed in the decision of initiation or discontinuation of antibiotic therapy in adults. The discontinuation may be applied if the PCT level after 3 days is lower than 0.25 ng/mL or as decreased by more

Pneumonia remains a global threat despite the development of newer antibiotics. Early diagnosis tools need to be widely available, including easily accessible molecular analyzes. The empirical antibiotic treatment should relay on site of care, severity index of the disease, comorbidities, cost effectiveness, but also on identifications of new risk factors challenging the Jean-Marie Ntumba Kayembe1 \* and Harry-César Ntumba Kayembe2

\*Address all correspondence to: dr12jmkayembe@yahoo.com

1 Pneumology Unit, Department of Internal Medicine, Faculty of Medicine, University of Kinshasa, DR Congo

2 Ecom-Alger, University of Kinshasa, DR Congo
