Consenso de neumonia 2010

Suplemento

Neumonía aguda adquirida en la comunidad en adultos: Actualización de los lineamientos para el tratamiento antimicrobiano inicial basado en la evidencia local del Grupo de Trabajo de Sudamérica (ConsenSur II)
Carlos Bantar1, Daniel Curcio2, Abel Jasovich3, Homero Bagnulo4, Álvaro Arango5, Luis Bavestrello6, Angela Famiglietti7, Patricia García8, Gustavo Lopardo9, MiriamLosanovscky10, Ernesto Martínez11, Walter Pedreira4, Luis Piñeyro4, Christian Remolif12, Flavia Rossi13 y Fabio Varón14

Updated acute community-acquired pneumonia in adults: Guidelines for initial antimicrobial therapy based on local evidence from the South American Working Group (ConsenSur II)
Community-acquired pneumonia (CAP) in adults is probably one of the infections affecting ambulatory patientsfor which the highest diversity of guidelines has been written worldwide. Most of them agree in that antimicrobial therapy should be initially tailored according to either the severity of the infection or the presence of comorbidities and the etiologic pathogen. Nevertheless, a great variability may be noted among the different countries in the selection of the primary choice in the antimicrobialagents, even for the cases considered as at a low-risk class. This fact may be due to the many microbial causes of CAP and specialties involved, as well as the different health-care systems effecting on the availability or cost of antibiotics. However, many countries or regions adopt some of the guidelines or design their own recommendations regardless of the local data, probably because of thescarcity of such data. This is the reason why we have developed a guideline for the initial treatment of CAP by 2002 upon the basis of several local evidences in South America (ConsenSur I). However, several issues deserve to be currently rediscussed as follows: certain clinical scores other than the Physiological Severity Index (PSI) have become more popular in clinical practice (i.e. CURB-65,CRB-65); some pathogens have emerged in the region, such as community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) and Legionella spp; new evidences on the performance of the rapid test for the etiologic diagnosis in CAP have been reported (eg. urinary Legionella and pneumococcus antigens); new therapeutic considerations needs to be approached (i.e. dosage reformulation, duration oftreatment, emergence of novel antibiotics and clinical impact of combined therapy). Like in the first version of the ConsenSur (ConsenSur I), the various current guidelines have helped to organize and stratify the present proposal, ConsenSur II. Key words: Pneumonia, guidelines and respiratory infection. Palabras clave: Neumonía, guías, infección respiratoria.
Conflicto de intereses El grupoConsenSur II declara que el patrocinador no influenció sobre el contenido del documento.

1

Hospital San Martín, Paraná,

Argentina; 2Sanatorio Itoiz, Buenos Aires, Argentina; 3Hospital Bocalandro, Buenos Aires, Argentina;
4

Hospital Maciel, Montevideo,

Uruguay; 5Fundación Cardioinfantil, Bogotá, Colombia; 6Clinica Reñaca, Viña del Mar, Chile; 7Hospital de Clínicas, Buenos Aires, Argentina;8

Escuela de Medicina, Universidad Fundación Centro de Estudios

Católica de Chile, Santiago, Chile;
9

Infectológicos, Buenos Aires, Argentina; 10Clínica y Maternidad SuizoArgentina, Buenos Aires, Argentina;
11

Hospital Universitario del Valle,

Cali, Colombia; 12Hospital Héroes de Malvinas, Merlo, Argentina;
13

Universidad de Sao Pablo, Sao

Pablo, Brasil; 14FundaciónNeumonológica, Bogotá, Colombia. Correspondencia a: Carlos Bantar cbantar@arnet.com.ar

Declaración de transparencia de los miembros del Consensur II Los miembros del comité cumplieron los requerimientos del Director General y de los Coordinadores con respecto a la transparencia de la declaración personal de intereses. A continuación se suministra un resumen de la declaración de intereses durante el...