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mkdir -p "/tmp/workspace/translated-handbook/source" "/tmp/workspace/translated-handbook/output" && python -c "from pypdf import PdfReader; p=PdfReader('/tmp/workspace/attachments/849d60a0-565a-45db-ba76-680315469778/2_5345999948573876542 1.pdf'); print('PAGES',len(p.pages)); [print('\\n===== PAGE',i+1,'=====\\n', (pg.extract_text() or '')[:12000]) for i,pg in enumerate(p.pages)]" > "/tmp/workspace/translated-handbook/source/extracted.txt" && python -c "from pypdf import PdfReader; p=PdfReader('/tmp/workspace/attachments/849d60a0-565a-45db-ba76-680315469778/2_5345999948573876542 1.pdf'); print(len(p.pages))"

"community-acquired pneumonia" AND antibiotic

community acquired pneumonia outpatient antibiotic treatment guideline adults 2025

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~/translated-handbook

2025 ATS community acquired pneumonia antibiotic guideline adult outpatient duration

"community-acquired pneumonia" AND antibiotic

cat > "/tmp/workspace/translated-handbook/source/create_handbook.py" <<'PY' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT from reportlab.lib.units import cm from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, PageBreak, Table, TableStyle, KeepTogether, HRFlowable from reportlab.pdfbase.pdfmetrics import stringWidth from reportlab.lib.colors import HexColor OUT='/tmp/workspace/translated-handbook/output/Community_Acquired_Pneumonia_English_Handbook.pdf' W,H=A4 navy=HexColor('#113B5C'); teal=HexColor('#007C83'); aqua=HexColor('#DFF6F4'); blue=HexColor('#E9F2FB'); orange=HexColor('#FFB25B'); red=HexColor('#B8444A'); gold=HexColor('#FFE4A6'); ink=HexColor('#203040'); grey=HexColor('#667788'); pale=HexColor('#F6F9FC') styles=getSampleStyleSheet() styles.add(ParagraphStyle(name='TitleX', fontName='Helvetica-Bold', fontSize=29, leading=34, textColor=colors.white, alignment=TA_CENTER, spaceAfter=14)) styles.add(ParagraphStyle(name='SubX', fontName='Helvetica', fontSize=13, leading=18, textColor=HexColor('#E8F8FF'), alignment=TA_CENTER)) styles.add(ParagraphStyle(name='H1X', fontName='Helvetica-Bold', fontSize=18, leading=22, textColor=navy, spaceBefore=8, spaceAfter=9)) styles.add(ParagraphStyle(name='H2X', fontName='Helvetica-Bold', fontSize=12, leading=15, textColor=teal, spaceBefore=5, spaceAfter=5)) styles.add(ParagraphStyle(name='BodyX', fontName='Helvetica', fontSize=9.4, leading=13.2, textColor=ink, spaceAfter=6)) styles.add(ParagraphStyle(name='SmallX', fontName='Helvetica', fontSize=8.1, leading=10.4, textColor=ink)) styles.add(ParagraphStyle(name='CalloutX', fontName='Helvetica-Bold', fontSize=9.2, leading=13, textColor=navy)) styles.add(ParagraphStyle(name='FootX', fontName='Helvetica', fontSize=7.5, leading=9, textColor=grey, alignment=TA_CENTER)) def P(t, style='BodyX'): return Paragraph(t, styles[style]) def bullet(t): return P('&bull; '+t) def section(title, kicker=None): arr=[Paragraph(title, styles['H1X']), HRFlowable(width='100%', thickness=2, color=teal, spaceAfter=8)] if kicker: arr.append(P(kicker,'SmallX')) return arr def callout(label, text, bg=aqua): table=Table([[P('<b>'+label+'</b><br/>'+text,'CalloutX')]], colWidths=[17.0*cm]) table.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,-1),bg),('BOX',(0,0),(-1,-1),0.5,teal),('LEFTPADDING',(0,0),(-1,-1),10),('RIGHTPADDING',(0,0),(-1,-1),10),('TOPPADDING',(0,0),(-1,-1),8),('BOTTOMPADDING',(0,0),(-1,-1),8)])) return table def tbl(data,widths,header=True,fontsize=7.6): d=[] for row in data: d.append([P(str(x),'SmallX') for x in row]) t=Table(d,colWidths=widths,repeatRows=1 if header else 0, hAlign='LEFT') style=[('VALIGN',(0,0),(-1,-1),'TOP'),('GRID',(0,0),(-1,-1),0.35,HexColor('#B8CBD6')),('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5),('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4)] if header: style += [('BACKGROUND',(0,0),(-1,0),navy),('TEXTCOLOR',(0,0),(-1,0),colors.white),('FONTNAME',(0,0),(-1,0),'Helvetica-Bold')] for r in range(1 if header else 0,len(d)): if r%2: style.append(('BACKGROUND',(0,r),(-1,r),pale)) t.setStyle(TableStyle(style)); return t def header_footer(canvas,doc): canvas.saveState() if doc.page>1: canvas.setFillColor(navy); canvas.rect(0,H-1.15*cm,W,1.15*cm,fill=1,stroke=0) canvas.setFillColor(colors.white); canvas.setFont('Helvetica-Bold',8.5); canvas.drawString(1.45*cm,H-.72*cm,'COMMUNITY-ACQUIRED PNEUMONIA') canvas.setFont('Helvetica',7.5); canvas.drawRightString(W-1.45*cm,H-.72*cm,'English translation handbook') canvas.setStrokeColor(HexColor('#C9D7E2')); canvas.line(1.45*cm,.95*cm,W-1.45*cm,.95*cm) canvas.setFillColor(grey); canvas.setFont('Helvetica',7.4); canvas.drawString(1.45*cm,.58*cm,'Translated from the supplied Russian-language source document') canvas.drawRightString(W-1.45*cm,.58*cm,f'Page {doc.page}') canvas.restoreState() story=[] # COVER story += [Spacer(1,1.4*cm)] cover=Table([[P('MINISTRY OF HEALTH<br/>OF THE REPUBLIC OF BELARUS','SubX')],[P('Community-Acquired<br/>Pneumonia','TitleX')],[P('Analysis of Antibacterial Therapy in the Outpatient and Polyclinic Setting','SubX')],[Spacer(1,.25*cm)],[P('English Translation Handbook<br/><font size="9">Prepared from the submitted academic paper</font>','SubX')]], colWidths=[17*cm]) cover.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,-1),navy),('BOX',(0,0),(-1,-1),0,navy),('TOPPADDING',(0,0),(-1,-1),16),('BOTTOMPADDING',(0,0),(-1,-1),16),('LEFTPADDING',(0,0),(-1,-1),18),('RIGHTPADDING',(0,0),(-1,-1),18)])) story += [cover,Spacer(1,.8*cm),callout('Prepared by','Intern physician: <b>Vishal Vishal</b><br/>Gomel, 2026',blue),Spacer(1,.6*cm),P('Translation note', 'H2X'),P('This handbook translates and visually reorganizes the full content of the supplied Russian-language paper. Antibiotic names and recommendations are retained as source content for educational translation. They are not individualized medical advice and may not reflect current local protocols, resistance patterns, licensing, or guideline updates.', 'BodyX'),Spacer(1,.3*cm),callout('For clinical use','Diagnosis and treatment decisions require a qualified clinician, patient-specific assessment, and current local guidance.',gold),PageBreak()] # TOC story += section('Contents') contents=[['1','Introduction'],['2','Etiology and classification'],['3','Diagnosis'],['4','Differential diagnosis'],['5','Analysis of antibacterial therapy'],['6','Prognosis'],['7','Prevention'],['8','References and translator notes']] story.append(tbl(contents,[1.2*cm,15.8*cm],header=False)); story += [Spacer(1,.5*cm),callout('At a glance','Community-acquired pneumonia (CAP) is pneumonia acquired outside a hospital. Commonly identified causes include <i>Streptococcus pneumoniae</i>, <i>Haemophilus influenzae</i>, atypical bacteria, and viruses.',aqua),Spacer(1,.3*cm),P('Source structure', 'H2X'),P('The original document presents an academic overview of CAP, diagnosis, differential diagnosis, empiric and pathogen-directed antibacterial therapy, prognosis, preventive measures, and a reference list. Tables have been reformatted for readability.', 'BodyX'),PageBreak()] # intro etiology story += section('1. Introduction') story += [P('Community-acquired pneumonia is pneumonia acquired outside a hospital. The pathogens most often identified are <i>Streptococcus pneumoniae</i>, <i>Haemophilus influenzae</i>, atypical bacteria such as <i>Chlamydia pneumoniae</i>, <i>Mycoplasma pneumoniae</i>, and <i>Legionella</i> species, as well as viruses.'),P('<i>Staphylococcus aureus</i>, including methicillin-resistant <i>S. aureus</i>, and <i>Pseudomonas aeruginosa</i> may cause CAP in patients with pathogen-specific risk factors.'),P('Symptoms and complaints include fever, cough, sputum production, pleuritic chest pain, shortness of breath, tachypnea, and tachycardia. Diagnosis is based on clinical examination and chest radiography. Treatment is generally initiated with empirically selected antibiotics. Prognosis is favorable for relatively young or healthy patients, but pneumonia can be severe or fatal in older or debilitated patients.'),*section('2. Etiology and classification')] story += [P('Pneumonia is an infectious disease characterized by focal involvement of the respiratory portions of the lungs with intra-alveolar exudation, accompanied by fever and intoxication.'),P('<b>Types of pneumonia:</b> community-acquired (non-hospital); hospital-acquired (nosocomial); aspiration and abscess-forming pneumonia; and pneumonia in immunodeficiency states, including congenital immunodeficiency, HIV infection, and neutropenia. By rate of development, pneumonia may be acute, subacute, or chronic.'),P('Radiography and CT-based classification includes lobar pneumonia, bronchopneumonia, interstitial pneumonia, lung abscess, hilar adenopathy, and pleural effusion.'),callout('Epidemiology and risk','The source reports CAP incidence of 8 to 15 per 1,000 population, with greater frequency in older adults. Listed risk factors for illness and death include alcohol misuse, smoking, chronic obstructive lung disease, congestive heart failure, immunodeficiency, and crowded living conditions.',gold),PageBreak()] # etiologic agents story += section('Etiologic agents and host associations') story += [P('<i>Streptococcus pneumoniae</i> (pneumococcus) is described as the most frequent CAP pathogen, accounting for 20% to 60% of cases in the source. <i>Mycoplasma pneumoniae</i> and <i>Chlamydia pneumoniae</i> are more common among younger and middle-aged people. Their etiologic role is less prominent in older patients.'),P('<i>Legionella pneumophila</i> is less common but associated with high mortality. <i>M. pneumoniae</i>, <i>C. pneumoniae</i>, and <i>L. pneumophila</i> are traditionally called “atypical” because of their clinical and diagnostic characteristics.'),P('<i>H. influenzae</i> and <i>Moraxella catarrhalis</i> more often cause pneumonia in smokers and in chronic bronchitis. <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i>, and less often other Enterobacteriaceae, are generally encountered in patients with diabetes mellitus, congestive heart failure, or other risk factors. The probability of staphylococcal pneumonia rises in older people, after aspiration, or after influenza.'),P('Pneumococcus, Enterobacteriaceae, and <i>S. aureus</i> predominate among causes of severe CAP in the source.'),P('The original paper states that severe CAP may warrant broad-spectrum initial therapy and antibiotic combinations that cover the greatest number of likely pathogens. This is historical source material and should be reconciled with current local guidance and stewardship practice.', 'SmallX'),PageBreak()] # diagnosis story += section('3. Diagnosis') story += [P('Diagnosis is usually based on fever or low-grade fever, cough, and sputum production. Chills, dyspnea, and chest pain occur less often. Chest pain is thought to be associated with pleural irritation.'),P('In lobar pneumonia, signs of lung consolidation may be present: dullness to percussion, bronchial breathing, and increased vocal fremitus. Local fine crackles or crepitation are most commonly heard on auscultation.'),P('Radiography provides evidence of lobar or focal infiltration of the lung parenchyma and may demonstrate complications such as abscess formation and exudative pleurisy.'),P('<b>Studies listed in the source for hospitalized CAP:</b>'),bullet('Chest radiography.'),bullet('Arterial blood gases and pH.'),bullet('Complete blood count.'),bullet('Blood chemistry, including liver and kidney function tests and electrolyte levels.'),bullet('Gram-stained sputum smear and sputum culture.'),bullet('Blood cultures in severe disease.'),bullet('If a pleural effusion is present: Gram stain and culture of fluid obtained by puncture.'),PageBreak()] # diagnosis labs story += section('Diagnostic laboratory and microbiology details') story += [P('A complete blood count often shows leukocytosis above 10.0 × 10<super>9</super>/L, a left shift, and toxic granulation of neutrophils. Leukocytosis above 15.0 × 10<super>9</super>/L usually indicates a bacterial infection. Leukopenia below 3.0 × 10<super>9</super>/L or leukocytosis above 25.0 × 10<super>9</super>/L are unfavorable prognostic signs. Anemia may indicate mycoplasma infection or chronic or complicated pneumonia.'),P('For etiologic diagnosis, sputum is generally Gram stained and examined microbiologically. Transtacheal aspiration or bronchoscopy is usually used for atypical symptoms, resistance to ongoing antibacterial therapy, or severe pneumonia.'),P('<b>Sputum study requirements in the source:</b>'),bullet('Obtain material before antibiotic therapy is prescribed.'),bullet('Perform culture within 2 to 5 hours after specimen collection.'),bullet('A sample is considered suitable when microscopy at 100× shows more than 25 neutrophils and fewer than 10 squamous epithelial cells per field of view.'),P('Bacterioscopy can often identify a likely pathogen and support selection of antibacterial therapy before culture results are available. In severe pneumonia, two blood cultures should be performed before antibiotics. Severe disease also supports testing for legionellosis, especially during endemic or epidemic outbreaks and in immunocompromised people. In uncertain cases, sputum smears for acid-fast bacilli and culture for <i>Mycobacterium tuberculosis</i> are also performed.'),PageBreak()] # differential story += section('4. Differential diagnosis') story += [P('The source advises considering oncologic diseases such as bronchogenic or bronchioloalveolar cancer and lymphoma; immune diseases such as vasculitis, alveolitis, eosinophilic pneumonia, and alveolar proteinosis; and cardiovascular disorders such as congestive heart failure and pulmonary embolism.'),P('Hospital-acquired pneumonia should also be considered. Patients who undergo tracheal intubation and mechanical ventilation are at particular risk. An endotracheal tube does not completely seal the airway, impairs cough reflexes, removes upper-airway protection by the vocal cords, suppresses mucociliary clearance, and causes local inflammation. Infected secretions can accumulate above the inflated cuff and are difficult to remove by suction. The source reports that ICU mortality associated with hospital-acquired pneumonia may approach 40% to 50%.'),callout('Clinical reminder','An infiltrate and respiratory symptoms have multiple possible causes. Clinical context, imaging, severity assessment, and appropriate testing guide the distinction between infection and mimics.',blue),PageBreak()] # antimicrobial table story += section('5. Analysis of antibacterial therapy') story += [P('Antibacterial therapy is the foundation of etiologic treatment of pneumonia. When etiology is known, the source recommends selecting antibiotics with activity against the identified flora. The table below is a direct English rendering and reformatting of the original table.'),callout('Safety and currency note','This table reports the submitted source. It does not provide doses, contraindications, renal adjustment, allergy assessment, microbiology results, or current resistance guidance. Do not use it as a prescribing protocol.',gold)] data=[['Pathogen','Antibiotics of choice in source','Alternatives in source'],['<i>Streptococcus pneumoniae</i>','Penicillins; amoxicillin; ceftriaxone; cefotaxime; cefuroxime','Macrolides; fluoroquinolones*; beta-lactams; doxycycline'],['<i>Haemophilus influenzae</i>','Second- or third-generation cephalosporins; trimethoprim/sulfamethoxazole','Beta-lactam/beta-lactamase inhibitor combinations; tetracyclines; chloramphenicol; fluoroquinolones'],['<i>Moraxella catarrhalis</i>','Second- or third-generation cephalosporins; trimethoprim/sulfamethoxazole; amoxicillin/clavulanate','Macrolides; fluoroquinolones'],['<i>Mycoplasma pneumoniae</i>; <i>Chlamydia pneumoniae</i>','Macrolides','Fluoroquinolones; doxycycline; azithromycin'],['<i>Legionella pneumophila</i>','Macrolides; rifampicin','Fluoroquinolones + rifampicin; doxycycline + rifampicin'],['Anaerobic flora','Metronidazole; clindamycin','Beta-lactam/beta-lactamase inhibitor combinations; ampicillin/amoxicillin; imipenem/meropenem'],['Enterobacteriaceae (<i>E. coli</i>, <i>Klebsiella</i>, <i>Proteus</i>, <i>Enterobacter</i>)','Second- or third-generation cephalosporins + aminoglycosides','Aztreonam; imipenem; beta-lactam/beta-lactamase inhibitor combinations; fluoroquinolones'],['<i>S. aureus</i>','Oxacillin; rifampicin','Cefazolin or cefuroxime; vancomycin; fluoroquinolones if in-vitro susceptible']] story += [tbl(data,[3.45*cm,6.45*cm,7.1*cm]),Spacer(1,.25*cm),P('*The source defines fluoroquinolones as levofloxacin, sparfloxacin, and other agents in this class with pronounced activity against <i>S. pneumoniae</i>.','SmallX'),PageBreak()] # risk table story += section('Empiric therapy: epidemiologic and clinical context') story += [P('Because the pathogen is usually unknown, first-line antibiotic selection is often empirical. The source advises considering epidemiologic and clinical circumstances. The following table translates the original list of risk factors and likely pathogens.'),tbl([['Risk factor','Likely pathogen(s) in source'],['Age under 25 years','Mycoplasma; chlamydia; pneumococcus'],['Age over 60 years','Pneumococcus; <i>H. influenzae</i>'],['Chronic bronchitis','Pneumococcus; <i>H. influenzae</i>; Moraxella; Gram-negative bacilli'],['Smoking','<i>H. influenzae</i>; Moraxella'],['Alcohol misuse','Pneumococcus; Klebsiella; anaerobes; <i>M. tuberculosis</i>'],['Intravenous drug use','Staphylococcus; anaerobes; pneumocystis; <i>M. tuberculosis</i>'],['Loss of consciousness, seizures, aspiration','Anaerobes'],['Contact with birds','Chlamydia; rickettsiae'],['Influenza epidemic','Influenza virus; pneumococcus; staphylococcus; <i>H. influenzae</i>'],['HIV infection','Pneumocystis; pneumococcus; Legionella; Gram-negative bacilli; <i>M. tuberculosis</i>']],[5.7*cm,11.3*cm]),Spacer(1,.28*cm),P('In intensive care, the source describes combinations of macrolides (erythromycin, azithromycin, clarithromycin) or fluoroquinolones (levofloxacin, ofloxacin, ciprofloxacin) with third-generation cephalosporins (cefotaxime, ceftriaxone), or beta-lactam/beta-lactamase inhibitor combinations such as ampicillin/sulbactam or amoxicillin/clavulanate.'),PageBreak()] # therapeutic support prognosis prevention story += section('Supportive care, prognosis, and prevention') story += [P('For severe pneumonia, the source states that antibacterial medicines are given intravenously at least until clinical effect is achieved and should be started immediately after a diagnosis of pneumonia. It also lists anti-inflammatory medicines, expectorants (acetylcysteine, bromhexine), bronchodilators (aminophylline), infusion therapy with electrolyte, colloid, and glucose solutions for detoxification, oxygen therapy by mask or nasal catheters for respiratory failure, mechanical ventilation in severe cases, and physiotherapy and therapeutic exercise after stabilization.'),*section('6. Prognosis')] story += [P('Prognosis depends on pathogen virulence, patient age, underlying diseases, immune reactivity, and adequacy of treatment. Complicated pneumonia, immunodeficiency, and pathogen resistance to antibacterial therapy are unfavorable factors. The source highlights pneumonia caused by staphylococcus, <i>Pseudomonas aeruginosa</i>, or Klebsiella in children under one year of age as particularly hazardous, with reported mortality from 10% to 30%.'),P('With timely and adequate treatment, pneumonia resolves. The source lists the following possible outcomes based on lung-tissue changes:'),bullet('Complete restoration of lung structure: 70%.'),bullet('Formation of a localized area of pneumosclerosis: 20%.'),bullet('Formation of localized carnification: 7%.'),bullet('Reduction in size of a segment or lobe: 2%.'),bullet('Shrinkage of a segment or lobe: 1%.'),PageBreak()] story += section('7. Prevention') story += [P('Measures to prevent pneumonia include physical conditioning, maintaining immune health, avoiding hypothermia, treatment of chronic nasopharyngeal infection foci, dust control, and stopping smoking and alcohol misuse. For debilitated bed-bound patients, the source recommends breathing exercises, therapeutic exercise, massage, and antiplatelet agents (pentoxifylline, heparin).'),P('The original paper also identifies hand hygiene, mask use, and elevating the head of the bed as important preventive measures. Hand hygiene between contact with different patients is an essential requirement for healthcare workers. It can reduce transfer of pathogens between patients and contamination of healthcare workers’ hands with potentially pathogenic bacteria.'),callout('Current-practice notice','The submitted paper contains older sources and recommendations. Current CAP guidance should be consulted for diagnostic approaches, antimicrobial choice and duration, and prevention policies. Recent evidence reviews include PMID 38360961, PMID 40404065, and PMID 40602496.',aqua),PageBreak()] # refs story += section('8. References from the supplied document') refs=['Avdeev, S. N. Aspiration pneumonia. <i>Clinical Microbiology and Antimicrobial Chemotherapy</i>. 2008; 10(3):216-234.','Woodhead M, et al. Guidelines for the management of adult lower respiratory tract infections. <i>Clinical Microbiology and Infection</i>. 2011;17(Suppl 6):1-24.','Bilchenko O. S., et al. Pneumonia in patients with immunodeficiency. <i>Experimental and Clinical Medicine</i>. 2010;4(49):99-102.','Metlay J. P., et al. Testing Strategies in the Initial Management of Patients with Community-Acquired Pneumonia. <i>Annals of Internal Medicine</i>. 2003;138(2):109-118.'] story += [P(str(i+1)+'. '+r) for i,r in enumerate(refs)] story += [Spacer(1,.25*cm),P('Translator and formatting note','H2X'),P('Translated from “Analysis of antibacterial therapy of pneumonias at the outpatient-polyclinic stage,” submitted as a paper associated with the Belarusian State Medical University. Layout, section labels, and callouts have been added for readability. The information is educational and source-faithful, with limited editorial normalization of scientific names and typography.'),Spacer(1,.25*cm),callout('Updated evidence flag','Recent systematic reviews on antibiotics for CAP were identified: Kurotschka et al. (2024), PMID 38360961; Hu et al. (2025), PMID 40404065; and Ghadimi et al. (2025), PMID 40602496. These may update or qualify the legacy source content.',gold),Spacer(1,.8*cm),P('End of translated handbook','FootX')] doc=SimpleDocTemplate(OUT,pagesize=A4,rightMargin=1.45*cm,leftMargin=1.45*cm,topMargin=1.65*cm,bottomMargin=1.25*cm,title='Community-Acquired Pneumonia: English Translation Handbook',author='Translated from supplied source') doc.build(story,onFirstPage=header_footer,onLaterPages=header_footer) print(OUT) PY python "/tmp/workspace/translated-handbook/source/create_handbook.py" python -c "from pypdf import PdfReader; p=PdfReader('/tmp/workspace/translated-handbook/output/Community_Acquired_Pneumonia_English_Handbook.pdf'); print('pages',len(p.pages)); print('first',p.pages[0].extract_text()[:200]); print('last',p.pages[-1].extract_text()[-300:])"

~/translated-handbook/output