Context: Community-acquired pneumonia (CAP) refers to pneumonia attained outside the hospital or less than 48 hours before admission, which is a significant cause of mortality and morbidity, especially in major comorbidities and older age. Several microorganisms contribute to developing CAP, primarily Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis, and atypical pathogens, e.g., Mycoplasma pneumonia. The incidence of these microorganisms depends on outpatient or inpatient settings. Administering appropriate treatment among available antibiotics is a critical issue affecting patient survival. Methods: With a multidisciplinary panel expert, this document offers evidence-based recommendations for managing CAP in Iran. Results: The document evaluated the availability of antimicrobial agents and local antibiotic resistance patterns based on 94 relevant published studies from Google Scholar, Scopus, PubMed, Scientific Information Database (SID), Iran Medex, Iran doc, Mag Iran, PubMed, and expert opinions. Conclusions: The panel addressed two main parts of rational recommendations for managing outpatients or hospitalized patients with CAP.

Introduction: Haemophilus. influenzae and Moraxella. catarrhalis are two common pathogens in respiratory tract infections. Antimicrobial resistance to these pathogens occurs over years. Therefore, we decided to carry out a systematic review to investigate the antibiotic resistance and sensitivity of these pathogens in Iran.Material and method: All recent original articles and studies related to the antimicrobial resistance in H. influenza and M. cattarhalis in Iran up to 2022 were investigated in English and Persian databases. Result: The prevalence of antibiotic susceptibility in H. influenza to levofloxacin (100%), cefotaxim (78.8%), clarithromycin (71.4%) and ceftriaxone (71.4-80%) was upmost. Resistances to ciprofloxacin were varied. In addition, about 50% of isolated had resistant to ampicillin. The prevalence of M. cattarhalis resistance in Iran including penicillin was 70-100%, erythromycin was 0%, and in three of our study of our studies, the resistance rate of ciprofloxacin was 0% whereas in one study 70% of isolated M.cattarhalis had resistance to ciprofloxacin also, resistances to amoxicillin/clavulanate were varied.Conclusion: According to the study, most isolates of H. influenzae are sensitive to levofloxacin, but resistance to macrolides and third generation cephalosporins are increasing; and the majority of M. cattarhalis was resistant to penicillin.

Background: There are increasing reports regarding macrolide resistance in Mycoplasma pneumoniae, particularly in Asia. Indiscriminate consumption of macrolide could be an alarming sign worldwide. We aimed to systematically review and analyze the prevalence and pattern of resistance in Mycoplasma pneumoniaeaccording to the recent studies.Methods: We searched authentic scienti c sources and databases, and reference lists of relevant articles from January 1, 2017, to April 1, 2022. Meta-analyses were accomplished on the extracted and evaluated epidemiological data for proportion outcome variables, which included factors associated with Macrolide resistance, A2063G and A2064G.Results: Most of the included studies were conducted in Asia (a total number of 10353 patients). Twentynine quali ed studies were included in order to evaluation of macrolide resistance. The overall pooled prevalence was 52% (38%-65%), I2=100%; p<0.001. While subgroups analyses revealed that the pooled prevalence for America (3 studies), Asia (23 studies), and Europe (3 studies) was 8% (6%-10%), 63% (52%-75%), and 4% (2%-7%), respectively.Seventeen eligible studies for determining of A2063G and 14 for A2064G were analyzed. Global pooled prevalence was 75% (68%-83%), I2=100%; p<0.001, and 4 %( 2%-5%), I2=89%; p<0.001 for A2063G and A2064G, respectively.Pooled prevalence of A2063G for America, Asia and Europe was 10% (4%-15%), 91% (88%-93%) and 5% (2%-9%), respectively. Conclusion: While the prevalence of macrolide-resistant MP is quite low in America, it is a great dilemma in East Asia and the low prevalence in most countries could be underestimated. This study revealed an increasing trend in macrolide resistance. Indiscriminate and improper use of macrolides may be a warning in this regard.