Guidelines for the management of community ... - Brit Thoracic

BTS guidelines
Figure 2 Synopsis of the management
of adult patients seen in hospital with
suspected community acquired
pneumonia, with cross reference to
relevant sections in the document text.
1.3.2 Defining the terms ‘‘atypical pneumonia’’ and ‘‘atypical
pathogens’’
The term ‘‘atypical pneumonia’’ has outgrown its historical
usefulness and we do not recommend its continued use as it
implies (incorrectly) a distinctive clinical pattern (see Section
4.2).
For the purposes of these guidelines, the term ‘‘atypical
pathogens’’ is used to define infections caused by:
c Mycoplasma pneumoniae;
c Chlamydophila pneumoniae;
c Chlamydophila psittaci; and
c Coxiella burnetii.
These pathogens are characterised by being difficult to
diagnose early in the illness and are sensitive to antibiotics
other than b-lactams such as macrolides, tetracyclines or
fluoroquinolones which are concentrated intracellularly, which
is the usual site of replication of these pathogens. As such, we
conclude that the term ‘‘atypical pathogens’’ is still useful to
clinicians in guiding discussion about aetiology and management
of CAP.
iii8
Legionella spp, although sharing some of these characteristics,
are not considered to be an ‘‘atypical pathogen’’ for the purpose
of this document as there are different species and these can be
acquired both in the community and hospital environment.
1.3.3 Defining the term ‘‘elderly’’
There is no agreed age cut-off to define the term ‘‘elderly’’.
When referring to published research, wherever possible we
define the age limits used in the relevant studies.
1.4 What is the target end user audience?
We want these guidelines to be of value to:
c Hospital-based medical and other staff involved with
managing adult patients with CAP.
c General practitioners.
c Those teaching about the subject at both undergraduate and
postgraduate level.
The guidelines have been developed to apply to the UK
healthcare system and population, but they might also be of
value to other countries which operate similar healthcare
Thorax 2009;64(Suppl III):iii1–iii55. doi:10.1136/thx.2009.121434