Response

Thank you for the correspondence by Dr Blot et al. We agree with their comments about the debate of which antimicrobial therapy is optimal for patients presenting with community-acquired pneumonia. After carrying out a series of systematic reviews,1Hill A.T. Gold P.M. El Solh A.A. et al.Adult outpatients with acute cough due to suspected pneumonia or influenza: CHEST Guideline and Expert Panel Report.Chest. 2019; 155: 155-167Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar those of us who made up the writing committee decided to take a pragmatic view to be clinically helpful and focused on antimicrobial stewardship. In doing so, we highlighted situations in which antibiotics could be avoided; when pneumonia was suspected, we suggested that local and national guidelines be followed because the prevalence of causative agents may differ internationally. The CHEST Expert Cough Panel, made up of > 50 international experts that reviewed the data and voted on the recommendations in the guidelines, agreed.1Hill A.T. Gold P.M. El Solh A.A. et al.Adult outpatients with acute cough due to suspected pneumonia or influenza: CHEST Guideline and Expert Panel Report.Chest. 2019; 155: 155-167Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar There is a long-standing debate about the benefits of antiviral therapy. In agreement with the advice of the Centers for Disease Control and Prevention,2Centers for Disease Control and PreventionInfluenza antiviral medications.https://www.cdc.gov/flu/professionals/antivirals/index.htmGoogle Scholar the CHEST Expert Cough Panel suggested that antiviral treatment be initiated within 48 h of symptom onset in outpatient adults with acute cough suspected of having influenza. We agree with the authors to target therapy for at risk groups, and polymerase chain reaction-based technology can be used in the acute settings to strengthen clinical decision-making. ∗CHEST Expert Cough Panel Collaborators: Todd M. Adams, MD (Webhannet Internal Medicine Associates of York Hospital, Moody, ME), Kenneth W. Altman, MD, PhD (Baylor College of Medicine, Houston, TX), Elie Azoulay, MD, PhD (University of Paris, Paris, France), Alan F. Barker, MD (Oregon Health & Science University, Portland, OR), Surinder S. Birring, MBChB, MD (Division of Asthma, Allergy and Lung Biology, King’s College London, Denmark Hill, London, England), Fiona Blackhall, MD, PhD (University of Manchester, Department of Medical Oncology, Manchester, England), Donald C. Bolser, PhD (College of Veterinary Medicine, University of Florida, Gainesville, FL), Louis-Philippe Boulet, MD, FCCP (Institut universitaire de cardiologie et de pneumologie de Québec, Quebec [IUCPQ], QC, Canada), Sidney S. Braman, MD, FCCP (Mount Sinai Hospital, New York, NY), Christopher Brightling, MBBS, PhD, FCCP (University of Leicester, Glenfield Hospital, Leicester, England), Priscilla Callahan-Lyon, MD (Adamstown, MD), Anne B. Chang, MBBS, PhD, MPH (Royal Children’s Hospital, QLD, Australia), Terrie Cowley (The TMJ Association, Milwaukee, WI), Paul Davenport, PhD (Department of Physiological Sciences, University of Florida, Gainesville, FL), Ali A. El Solh, MD, MPH (University at Buffalo, State University of New York, Buffalo, NY), Patricio Escalante, MD, MSc, FCCP (Mayo Clinic, Rochester, MN), Stephen K. Field, MD (University of Calgary, Calgary, AB, Canada), Dina Fisher, MD, MSc (University of Calgary, Respiratory Medicine, Calgary, AB, Canada), Cynthia T. French, PhD, FCCP (UMass Memorial Medical Center, Worcester, MA), Peter Gibson, MBBS (Hunter Medical Research Institute, NSW, Australia), Philip Gold, MD, MACP, FCCP (Loma Linda University, Loma Linda, CA), Cameron Grant, MB ChB, PhD (University of Auckland School of Medicine, Auckland, New Zealand), Susan M. Harding, MD, FCCP (Division of Pulmonary, Allergy and Critical Care Medicine Department of Medicine, University of Alabama at Birmingham, Birmingham, AL), Anthony Harnden, MB ChB, MSc (University of Oxford, Oxford, England), Adam T. Hill, MB ChB, MD (Royal Infirmary and University of Edinburgh, Edinburgh, Scotland), Richard S. Irwin, MD, Master FCCP (UMass Memorial Medical Center, Worcester, MA), Peter J. Kahrilas, MD (Feinberg School of Medicine, Northwestern University, Chicago, IL), Joanne Kavanagh, MBChB (Division of Asthma, Allergy and Lung Biology, King’s College London, Denmark Hill, London, England), Karina A. Keogh, MD (Mayo Clinic, Rochester, MN), Kefang Lai, MD, PhD (First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China), Andrew P. Lane, MD (Johns Hopkins University School of Medicine, Baltimore, MD), Kaiser Lim, MD (Mayo Clinic, Rochester, MN), J. Mark Madison, MD, FCCP (UMass Memorial Medical Center, Worcester, MA), Mark A. Malesker, PharmD, FCCP (Creighton University School of Pharmacy and Health Professions, Omaha, NE), Stuart Mazzone, PhD, FCCP (University of Melbourne, VIC, Australia), Lorcan McGarvey, MD (The Queen’s University Belfast, Belfast, Northern Ireland), Alex Molasoitis, PhD, MSc, RN (Hong Kong Polytechnic University, Hong Kong, China), Abigail Moore, BM BCh (University of Oxford, Oxford, England), M. Hassan Murad, MD, MPH (Mayo Clinic, Rochester, MN), Mangala Narasimhan, DO, FCCP (Hofstra-Northwell Health, Manhasset, NY), Peter Newcombe, PhD (School of Psychology University of Queensland, QLD, Australia), Huong Q. Nguyen, PhD, RN (Kaiser Permanente, Pasadena, CA), John Oppenheimer, MD (University of Medicine and Dentistry of New Jersey-Rutgers University), Mark Rosen, MD, Master FCCP (Icahn School of Medicine at Mount Sinai, New York, NY), Bruce Rubin, MEngr, MD, MBA (Virginia Commonwealth University, Richmond, VA), Richard J. Russell, MBBS (University of Leicester, Glenfield Hospital, Leicester, England), Jay H. Ryu, MD, FCCP (Mayo Clinic, Rochester, MN), Sonal Singh, MD, MPH (UMass Memorial Medical Center, Worcester, MA), Jaclyn Smith, MB ChB, PhD (University of Manchester, Manchester, England), Maeve P. Smith, MB ChB, MD (University of Alberta, Edmonton, AB, Canada), Susan M. Tarlo, MBBS, FCCP (Toronto Western Hospital, Toronto, ON, Canada), Julie Turmel, PhD (Institut universitaire de cardiologie et de pneumologie de Québec, Quebec [IUCPQ], QC, Canada), Anne E. Vertigan, PhD, MBA, BAppSc (SpPath) (John Hunter Hospital, NSW, Australia), Gang Wang, MD, PhD (Sichuan University, West China Hospital, Chengdu, China), Miles Weinberger, MD, FCCP (University of Iowa Hospitals and Clinics, Iowa City, IA). Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel ReportCHESTVol. 155Issue 1PreviewPatients commonly present to primary care services with upper and lower respiratory tract infections, and guidelines to help physicians investigate and treat acute cough due to suspected pneumonia and influenza are needed. Full-Text PDF Outpatients With Acute Cough: Urgent Need to Implement Streamlining of Antibiotic and Antiviral TreatmentsCHESTVol. 155Issue 5PreviewWe read with interest the recommendations of Hill et al1 in a recent issue of CHEST (January 2019). These recommendations are extremely relevant and pragmatic. However, some key points are worth debating. Full-Text PDF