Ambulant erworbene Pneumonie

The incidence of inpatient treatment of community-acquired pneumonia of immunocompetent patients is high with around 3/1000 persons and increases after the age of 60 years. It is associated with a 30-day and long-term mortality, moreover, it may be associated with (also irreversible) functional loss in survivors. The critical steps in initial management include assessment of the severity and determination of treatment goals. Patients with mild pneumonia can be treated in an outpatient setting, those with intermediate and severe pneumonia have an increased risk of death and must receive intensified inpatient treatment or intensive care treatment. The initial empiric antimicrobial treatment includes a beta lactam combined with a macrolide. Patients with severe pneumonia and hyperinflammation should also receive hydrocortisone. The evaluation of the treatment response is based on clinical criteria and repeated determination of the inflammatory status. The regular antimicrobial treatment duration is 5 days and 7 days in severe pneumonia. In the case of treatment failure the further procedure depends on the type of failure.