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Pneumonia should be considered as a possible diagnosis in a patient who presents with an acute illness with principal symptoms of cough, fever, deteriorating general condition and, particularly in the elderly, confusion and worsening of an underlying disease. The symptoms of pneumonia and acute bronchitis are very similar but are usually more severe in pneumonia. Any treatment prescribed must be effective against pneumococcal infection. Other causative agents must be considered if there are clinical or epidemiological reasons to suspect their presence. Parenteral antibiotics are indicated for patients whose general condition has deteriorated or who have a concomitant disease that affects the immune system. The first dose of oral medication should be administered in primary health care. Amoxicillin must be administered at least three times daily when treating pneumonia. Cefalexin is not recommended as first-line treatment in uncomplicated pneumonia because its spectrum is too broad, and its efficacy against pneumococci is inferior to that of amoxicillin . Ciprofloxacin is not suitable in community-acquired pneumonia as it is not sufficiently active against pneumococci. Levofloxacin and moxifloxacin are active against pneumococci. However, their use should be avoided in order to secure their performance should the resistance of pneumococci against penicillin continue to increase. Their widespread use would also jeopardise the treatment of urinary tract infections and infections caused by Gram-negative bacteria. About 30% of pneumococcal strains are resistant to the older macrolides, and macrolides are therefore not recommended to be used alone. Pneumococcal infection cannot be definitely excluded even during epidemics clearly caused by Mycoplasma or Chlamydophila pneumoniae. If the patient is allergic to penicillin, the recommended antimicrobial agent is telithromycin or doxycycline. Irrespective of the treatment chosen, all patients must be followed up and offered additional investigations and treatment, should recovery not progress as expected.
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