Recommendations for the treatment of severe in-hospital pneumonia. Spanish Society of Critical, Coronary, and Intensive Medicine. Spanish Society for Respiratory Tract Pathology. Spanish Society of Infectious Diseases and Clinical Microbiology

Given the sanitary repercussion of serious intrahospital pneumonia (SIP), representatives of three scientific societies (SEMICYUC; SEPAR and SEIMC) have developed during 2002 and 2003 a practical guide for its treatment. A task force was constituted to value five clinical situations related with the treatment of SIP: 1) critical revision of the existent guidelines and groups of risk definition; 2) entry criteria in ICU for SIP; 3) SIP treatment in function of the groups of risk; 4) special situations in SIP treatment, and 5) control treatment. After the bibliographical revision drafts were developed and discussed until the elaboration of the final document. It is necessary the stratification of the patients according to the presence or not of risk factors in order to make an appropriate use of treatments. SIP without risk factors can be treated with monotherapy with several antibiotics. SIP with risk factors specifies therapy combined with betalactamic plus aminoglycoside. Its substitution for a quinolon is a topic debate. Infections for multiresistance microorganisms require an individualized approach that can end up including the use of topical antibiotics. In SIP without microorganism isolation the use of a score system can be of utility in the taking of decisions. Revision of the therapeutic rule after 72 hours, carrying out the necessary adjustments according to the clinical evolution and microbiological results is necessary in all cases. Scientific evidence in the treatment of SIP allows the development of different strategies to achieve a higher efficiency both in antibiotic handling and in the control of its evolution.