GP · respiratory-health
Community-acquired pneumonia
Also known as CAP · Pneumonia assessment · Lower respiratory tract infection
GP-fellowship guide to community-acquired pneumonia: aetiology from the CDC surveillance study (rhinovirus commonest, S. pneumoniae leading bacterial pathogen), CURB-65 severity scoring, corticosteroid evidence for hospitalised CAP (RR 0.67 for mortality), Cochrane null result on short-course antibiotics in outpatients, and when to refer versus manage at home.
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Red flags
- CURB-65 score of 3 or more requires hospital admission — do not manage high-severity CAP in the community
- Confusion, urea above 7 mmol/L, respiratory rate 30 or more, or systolic BP below 90 mmHg each independently predict mortality and mandate urgent assessment
- Failure to improve after 48 hours of appropriate antibiotics demands CXR repeat, consideration of empyema/abscess, and specialist referral
Overview
Community-acquired pneumonia (CAP) is a leading infectious cause of hospitalisation and death among adults. In the CDC population-based surveillance study, a pathogen was detected in only 38% of cases — viruses were more commonly identified than bacteria.[2] This matters because it means empiric antibiotic choice is guided by severity and local resistance patterns, not by microbiological confirmation in most cases.
References4ShowHide
- [1]Jones BE, Jones J, Bewick T, Lim WS, Aronsky D, et al. CURB-65 pneumonia severity assessment adapted for electronic decision support. Chest, 2011.PMID 21163875
- [2]Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, et al. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med, 2015.PMID 26172429
- [3]López-Alcalde J, Rodriguez-Barrientos R, Redondo-Sánchez J, Muñoz-Gutiérrez J, Molero García JM, et al. Short-course versus long-course therapy of the same antibiotic for community-acquired pneumonia in adolescent and adult outpatients. Cochrane Database Syst Rev, 2018.PMID 30188565
- [4]Bergmann F, Pracher L, Sawodny R, Blaschke A, Gelbenegger G, et al. Efficacy and Safety of Corticosteroid Therapy for Community-Acquired Pneumonia: A Meta-Analysis and Meta-Regression of Randomized, Controlled Trials. Clin Infect Dis, 2023.PMID 37876267