The management of acute lower respiratory tract infection

Acute lower respiratory tract infection is associated with an increase of the morbidity, mortality and assistance cost. This review focus on the diagnosis and treatment of acute lower respiratory tract infection. There is not a gold standard in the microbiological diagnostic tests for the diagnosis of acute lower respiratory tract infection; thus, the choice of strategy used to diagnose will be dependent on consideration of local expertise and availability of personnel to perform the procedure. I suggest obtain a lower respiratory tract secretion sample by endotracheal aspirate for quantitative culture at the time of suspicion of acute lower respiratory tract infection; and by protected specimen brush and/or bronchoalveolar lavage in patients with a bad response to the initial antimicrobials used. In relation to the treatment of acute lower respiratory tract infection, I suggest the following approach: early onset of antimicrobial agents, choice of antimicrobial agents according the local bacteriologic patterns, combination therapy for the empiric treatment, de-escalation and monotherapy for the definitive treatment in responsive patients and with microorganism responsible documented, continuous infusion for betalactam antibiotics and vancomycin, single dayle dosage for aminoglycosides, administration of antimicrobials topically (inhaled or instilllated) in unresponsive patients, antibiotic heterogeneity, short-course of 7-10 days of antimicrobial therapy in patients with a good clinical response.