Adults
In 2001 the American Thoracic Society, drawing on the work of the British and Canadian Thoracic Societies, established guidelines for the management of adult CAP by dividing patients into four categories based on common organisms:
Healthy outpatients without risk factors: This group (the largest) is composed of otherwise-healthy patients without risk factors for DRSP, enteric gram-negative bacteria, pseudomonas or other, less common, causes of CAP. Primary microorganisms are viruses, atypical bacteria, penicillin-sensitive streptococcus pneumoniae and haemophilus influenzae. Recommended drugs are macrolide antibiotics, such as azithromycin or clarithromycin, for seven to ten days. A shorter course of these antibiotics has been investigated, however, there is not sufficient evidence to make recommendations. Outpatients with underlying illness or risk factors: Although this group does not require hospitalization, they have underlying health problems such as emphysema or heart failure or are at risk for DRSP or enteric gram-negative bacteria. They may be treated with a quinolone active against streptococcus pneumoniae (such as levofloxacin) or a β-lactam antibiotic (such as cefpodoxime, cefuroxime, amoxicillin or amoxicillin/clavulanic acid) and a macrolide antibiotic, such as azithromycin or clarithromycin, for seven to ten days. Hospitalized patients without risk for pseudomonas: This group requires intravenous antibiotics, with a quinolone active against streptococcus pneumoniae (such as levofloxacin), a β-lactam antibiotic (such as cefotaxime, ceftriaxone, ampicillin/sulbactam or high-dose ampicillin plus a macrolide antibiotic (such as azithromycin or clarithromycin) for seven to ten days. Intensive-care patients at risk for pseudomonas aeruginosa: These patients require antibiotics targeting this difficult-to-eradicate bacterium.
Enamel-renal syndrome is a rare autosomal recessive condition. This condition is also known as idiopathic multicentric osteolysis with nephropathy. It is characterised by dental abnormalities and nephrocalcinosis. Presentation
The dental abnormalities include

hypoplastic amelogenesis imperfecta
microdontia
intra-pulpal calcification
impacted posterior teeth with hyperplastic pericoronal follicles
gingival fibromatosis
ectopic calcifications on gingival and pericoronal tissues

Genetics
This condition is caused by mutations in the FAM20A gene. This gene encodes a protein – the Golgi apparatus associated secretory pathway pseudokinase. The gene is located on the long arm of chromosome 17 (17q24.2). Pathogensis
The protein is an allosteric activator of the Golgi serine/threonine protein kinase and is involved in biomineralization of teeth. Diagnosis
The diagnosis may be suspected on the basis of the constellation of clinical features. It is made by sequencing the FAM20A gene. This condition is usually diagnosed in childhood but may not be recognised until early adulthood. The diagnosis is suspected on the combination of nephrocalcinosis and dental abnormalities. Differential diagnosis
Epidermolysis bullosa
Jalili syndrome
Raine syndrome
Tricho-dento-osseous syndrome

Treatment
There is no specific treatment for this condition currently known and management of its various features is the norm. History
This condition was first described in 1972. == References ==