Management of community-acquired pneumonia: essential tips for the physician on call

Community-acquired pneumonia is a common clinical problem requiring admission to hospital, with a particularly high incidence in the elderly population and those with significant comorbidities. Diagnosis is made on the combination of a short history of respiratory symptoms and systemic ill-health with new examination and/or radiological features of consolidation. Multiple other infective and non-infective conditions can mimic community-acquired pneumonia, leading to misdiagnosis in 5-17% of cases. The CURB-65 score can identify patients with community-acquired pneumonia with a higher risk of mortality, but is insensitive at identifying patients requiring intensive care support and needs to be combined with clinical markers of potential severity. Both high admission levels of C-reactive protein and the failure of levels of C-reactive protein to decline by >50% by day 4 after admission are associated with higher risk of complications, need for ventilation or inotropic support, and mortality. Empirical antibiotic therapy for most patients admitted to hospital is combination of a ß-lactam and a macrolide. Short courses of antibiotics do not result in significantly different outcomes to longer courses unless the patient has developed complications such as a complex parapneumonic effusion. Implementation of a community-acquired pneumonia care bundle into clinical practice reduces mortality, and should be a high priority for all acute hospitals.