• Ahmet Gorkem Er, Alberto Antonio Romero Alonso, Ignacio Marin-Leon, Abdullah Sayiner, Stefano Bassetti, Kutay Demirkan, Patrick Lacor, Hartmut Lode, Wiktoria Lesniak, TanrioverMine DurusuMDSection of General Internal Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey., Ali Fuat Kalyoncu, Nicolás Merchante, and Serhat Unal.
• Hacettepe University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology, Turkey.
• Eur. J. Intern. Med. 2022 Dec 1; 106: 181-8.

BackgroundIn real-life settings, guidelines frequently cannot be followed since many patients are multimorbid and/or elderly or have other complicating conditions which carry an increased risk of drug-drug interactions. This document aimed to adapt recommendations from existing clinical practice guidelines (CPGs) to assist physicians' decision-making processes concerning specific and complex scenarios related to acute CAP.MethodsThe process for the adaptation procedure started with the identification of unsolved clinical questions (PICOs) in patients with CAP and continued with critically appraising the updated existing CPGs and choosing the recommendations, which are most applicable to these specific scenarios.ResultsSeventeen CPGs were appraised to address five PICOs. Twenty-seven recommendations were endorsed based on 7 high, 9 moderate, 10 low, and 1 very low-quality evidence. The most valid recommendations applicable to the clinical practice were the following ones: Respiratory virus testing is strongly recommended during periods of increased respiratory virus activity. Assessing the severity with a validated prediction rule to discriminate where to treat the patient is strongly recommended along with reassessing the patient periodically for improvement as expected. In adults with multiple comorbidities, polypharmacy, or advanced age, it is strongly recommended to check for possible drug interactions before starting treatment. Strong graded recommendations exist on antibiotic treatment and its duration. Recommendations on the use of biomarkers such as C-reactive protein or procalcitonin to improve severity assessment are reported.ConclusionThis document provides a simple and reliable updated guide for clinical decision-making in the management of complex patients with multimorbidity and CAP in the real-life setting.Copyright © 2022. Published by Elsevier B.V.

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