The cochairs of the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) Guideline for Treatment of Adults With Community-Acquired Pneumonia (CAP) have published their perspectives of the guideline as it relates to the management of patients with pneumonia associated with coronavirus disease 2019 (COVID-19). The authors’ comments were published in an Ideas and Opinions paper in the Annals of Internal Medicine.
The guideline cochairs wrote that empirical coverage for bacterial pathogens in patients with CAP is not required for all patients with confirmed pneumonia related to COVID-19. Additionally, the authors suggested that empirical antibiotic recommendations should be the same for patients with CAP and COVID-19, as it is likely that relevant bacterial pathogens are the same in patients with COVID-19-related pneumonia and those with CAP. Streptococcus pneumoniae, Haemophilus influenzae, Chlamydia pneumoniae, and Staphylococcus aureus are likely to be involved in pneumonia related to COVID-19, they added.
The guideline recommended a β-lactam (eg, ampicillin-sulbactam, ceftriaxone, or cefotaxime) plus either a macrolide (eg, azithromycin or clarithromycin) or doxycycline as combination therapy or a respiratory fluoroquinolone (eg, levofloxacin or moxifloxacin) as monotherapy for low-risk inpatients, whereas a β-lactam plus a macrolide or fluoroquinolone is recommended for high-risk inpatients. Also, the cochairs suggested that procalcitonin may be useful for limiting the overreliance on antibiotics in patients with COVID-19-related pneumonia. They endorsed a low procalcitonin value early in the course of a confirmed COVID-19 case to assist in either the withholding or early stopping of antibiotics, particularly in patients with less severe disease.
In addition, the guideline cochairs recommended against the adjunctive use of corticosteroids or other immunomodulating treatments in patients with COVID-19-related pneumonia, despite the likelihood of host immunologic processes playing a role in the lung damage associated with respiratory failure in the disease. The authors wrote that “[o]ngoing trials will help clarify whether immunomodulating therapies are beneficial in patients with COVID-19–related pneumonia.”
Metlay JP, Waterer GW. Treatment of community-acquired pneumonia during the coronavirus disease 2019 (COVID-19) pandemic [published online May 7, 2020]. Ann Intern Med. doi:10.7326/M20-2189