Table 4 The IDSA/ATS guidelines and corresponding practices in the Gulf region documented by the G-TinCAP study

Make a correct diagnostic of CAP

Consider cough, fever, and previous hospitalization for pneumonia.

The study captured the information about cough and fever as one of the clinical criteria for CAP.

Additional contributing risk factors for CAP include viral infections, neutropenia, pulmonary edema, altered consciousness, airway obstruction, and congenital pulmonary abnormalities.

Accompanying diseases for vital organs and other important information (eg malignancy, smoking and immunocompetency) were included in the baseline medical history.

Confirm the diagnosis

Chest radiography should be carried out for all suspected CAP patients to confirm the presence of pneumonia.

Chest auscultation was performed to detect any positive clinical findings (Crepitations, late inspiratory crackles or bronchial breathing).

70.6 % (n = 483) of the patient had new infiltrative changes in the radiogram of the chest. For the rest of the population radiogram was not performed or was not showing new infiltrative changes.

Identify high-risk CAP patients

Use IDSA/ATS algorithm to define which patients would benefit from hospitalisation.

The Fine criteria [13], which use all the parameters included in IDSA/ATS algorithm, were documented for all patients in this study.

Identify aetiologic agent responsible for CAP

Streptococcus pneumoniae is the most common etiologic agent for CAP.

Streptococcus pneumoniae alone was isolated in 46 % of cases (n = 36 specimens). The combination of S. pneumoniae and Klebsiella was isolated in 17 % of cases (n = 13 specimens). Klebsiella alone and Mycoplasma alone were isolated in 9 % (n = 7 specimens) and 8 % (n = 6 specimens) of cases respectively. S. viridans, Moraxella cararrhalis and Legionella were isolated in only 4 % of cases (n = 3 specimens).

Haemophilus influenzae and Chlamydia pneumoniae are generally the third or fourth most common organisms identified. Less common etiologic agents include oral anaerobes, Staphylococcus aureus, Legionella pneumophila and Moraxella catarrhalis.

Establish the aetiology and ensure that the therapy is pathogen directed

Use of sputum Gram’s stain and culture in all patients, whenever possible.

Information about Gram’s staining was not captured, but data was collected for the type of specimen used for isolation along with the type of test requested. Sputum was the specimen most frequently used.

Antimicrobial therapy

Empiric antimicrobial therapy should be initiated until laboratory results can be obtained to guide more specific therapy.

In all participants, empirical antimicrobial therapy was initiated immediately on the day of hospitalisation without waiting the laboratory results (culture and sensitivity tests).

Either fluoroquinolones or macrolides plus doxycycline are suggested for primary empiric therapy.

Levofloxacin or moxifloxacin (fluoroquinolones) were the most frequently used antimicrobial agents during hospital stay and after hospital discharge.

Route of administration for the antibiotic therapy

Switch to an appropriate oral antibiotic is recommended as soon as the patient’s condition is stable and he or she can tolerate oral therapy, often within 72 h.

The mean duration of intravenous administration of CAP therapy was around 81 h, though in 80 % of cases, switch to an oral antibiotic occurred within 3 days (72 h).

Treatment duration

As far as duration of treatment is concerned, the treatment for S. pneumoniae should generally continue for 7 to 14 days or until the patient is afebrile for 72 h.

During hospitalisation, the mean duration of treatment with antimicrobial agents was 3.5 days, ranging from 3 to 6 days.

Patients with atypical pathogens should be treated for 10 to 21 days.

After hospital discharge, the mean duration of treatment with antimicrobial agents was 7.4 days, ranging from 6 to 10 days.

Over 80 % of patients were prescribed a single antimicrobial agents for their home antibiotic therapy after discharge from hospital.