2019 ATS/IDSA Community-Acquired Pneumonia Guideline: Practice-Defining Updates

The 2019 ATS/IDSA CAP guideline introduces major shifts in diagnostic and empiric therapy strategies for adult patients.

ATS/IDSAcommunity-acquired pneumoniaCAPempiric therapydiagnostic testingprocalcitonincorticosteroidsMRSAPseudomonasGRADE Community-Acquired Pneumonia

Authors: Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG

Citation: Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. American journal of respiratory and critical care medicine. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581ST

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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Practice-changing Impact 3/5

This guideline requires immediate changes in empiric antibiotic selection, diagnostic testing, and clinical pathway construction for pharmacists managing CAP.

Evidence Grade: Moderate

Most recommendations are based on moderate or lower certainty per GRADE due to heterogeneous trials and limited high-quality studies in key clinical areas.

What's New / Changed vs. Prior Version

The 2019 ATS/IDSA CAP guideline update introduces the use of the PSI/PORT score over CURB-65 for site-of-care decisions. It now recommends a 5-day antibiotic course for clinically stable patients. Additionally, beta-lactam monotherapy is advised for outpatient CAP without comorbidities.

Key Recommendations

The PSI/PORT score is preferred over CURB-65 for determining site-of-care decisions (Class I, Level of Evidence A). For hospitalized non-ICU patients, a beta-lactam plus macrolide or respiratory fluoroquinolone is recommended (Class I, Level of Evidence A). For ICU patients, similar therapy is advised with either beta-lactam plus macrolide or a respiratory fluoroquinolone (Class I, Level of Evidence A). Beta-lactam monotherapy is suggested for outpatient CAP without comorbidities (Class IIa, Level of Evidence B). Azithromycin or doxycycline may be used for outpatients without comorbidities (Class I, Level of Evidence B). A 5-day antibiotic course is recommended for patients showing clinical improvement (Class IIa, Level of Evidence B).

Practice Impact for Pharmacists

Evaluate appropriateness of beta-lactam monotherapy in outpatients without comorbidities.
Monitor antibiotic duration to ensure alignment with the recommended 5-day course.
Prioritize PSI/PORT score over CURB-65 for determining site of care.

Implementation Considerations

Pharmacists may need training on PSI/PORT score calculations. Adjustments to electronic health records and order sets are necessary to reflect new antibiotic duration and regimen preferences. Costs may increase with combination therapies for inpatients.

Controversies / Dissenting Opinions

None noted

Full text source: Drive Reprocess – ATS/IDSA Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults