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The seemingly paradoxical fact that the incidence of severe bacterial infections caused by antibiotic resistant bacteria is also increasing is due to the fact that the most common organisms are inherently resistant. To date, most of these infections have been reported in the USA, and the overall burden of antibiotic resistance is highest in the USA. In part, this is because clinical practice is heavily influenced by the recommendations of the USA Centers for Disease Control and Prevention (CDC). The CDC, in collaboration with the Association for Professionals in Infection Control and Epidemiology, has developed the initial treatment guidelines for community acquired pneumonia, which recommend antibiotic therapy for the treatment of pneumonia in adults hospitalized with community acquired pneumonia. The CDC then launched a national education and promotion campaign to promote the guidelines. In response to the growing problem of antibiotic resistance, the CDC subsequently published a revised set of guidelines in September, 2012, which represents a modification of the earlier guidelines in an attempt to address the problem of increasing resistance to macrolides, clindamycin, and trimethoprim-sulfamethoxazole. The 2012 guidelines recommend that patients with community acquired pneumonia be treated with a combination of a fluoroquinolone (eg, levofloxacin or moxifloxacin) and a macrolide (eg, azithromycin or clarithromycin). However, the guidelines also suggest that patients with penicillin allergy or intolerance or those who are unlikely to tolerate fluoroquinolones should be treated with a combination of levofloxacin or moxifloxacin and a macrolide, and that patients who are not admitted to the hospital can be treated with levofloxacin or moxifloxacin alone. Data from recent studies show that this approach to pneumonia resulted in inappropriate antibiotic therapy in 20-30% of patients .
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