Guidelines for the management of adult lower respiratory tract infections

Guidelines for the management of adult lower respiratory tract infections

In 2005 the European Respiratory Society (ERS), in collaboration with The European Society for Clinical Microbiology and Infectious Diseases (ESCMID), published guidelines on the management of lower respiratory tract infections (LRTIs) in adults [1]. This document was based on published scientific literature up to the end of 2002. We have now updated these guidelines to include publications to May 2010. The taskforce responsible for guideline development has been sponsored by the ERS and ESCMID. Members of the taskforce are members of the sponsoring ERS and/or ESCMID.

Our objective is to provide evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. The target audience for the guidelines is thus all those whose routine practice includes the management of adult LRTI.

This short document covers only the statements and recommendations in the guidelines. A much more detailed document, including not only the recommendations but also background information for each recommendation with details about each new cited reference and the evidence grades, is available on the ERS and ESCMID websites. Both documents are divided into background information about microbial causes, antibiotic resistance and pharmacodynamics, and then the guideline section, which captures management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and acute exacerbations of bronchiectasis) and prevention. The guidelines are about the management of infection. This means that for conditions such as AECOPD, aspects of management that are unrelated to infection (e.g. use of steroids or bronchodilators) are not included.

Because this is an update, original data and publications have usually not been repeated and the reader is referred to the original publication [1] for this.


Using the same search filter as for the 2005 document (this is described in detail in the previous publication [1] and website documents—; we identified relevant manuscripts in PubMed published from July 2002 to May 2010. We retrieved 15 261 titles and loaded them into an electronic database. From these, 1677 titles were identified as potentially relevant publications by the expert panel members. The same process of evidence appraisal and grading and recommendation development and grading as in the 2005 document was used. As this is an update using the same methodologies, the layout of the document, including text, recommendations and evidence tables, is the same as 2005.

The document takes each clinical question for which there was a recommendation in the 2005 guideline and presents new information when available followed by a new recommendation. In some circumstances, because of lack of new evidence, or sometimes even in the presence of new evidence, the recommendation is unchanged from 2005. Where this is the case it is indicated.

In some parts of the guidelines new questions and recommendations have been added to cover relevant areas not included in the 2005 guidelines (e.g. aspiration pneumonia).


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