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Community-Acquired Pneumonia

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Diagnosis and Assessment of Disease Evaluation and Initial Management of CAP History, physical examination, chest radiograph No infiltrate: manage/evaluate for alternative diagnosis Infiltrate + compatible clinical features supporting diagnosis of pneumonia* Determine site of care: PSI, CURB-65, clinical judgment (PSI risk classes I, II, III; CURB-65 score 0-1) Empirical therapy (Table 4) (eg, frail condition, no response to oral therapy, severe social or psychiatric problems, substance abuse, unstable living situation, homelessness) Refer to Table 3 for clinical indications for more extensive diagnostic testing General medical ward: antibiotic first dose administered in ED Mitigating factors (PSI risk classes III, IV, V; CURB-65 score ≥ 2) Hospitalize patient Manage as outpatient Refer to Table 2 for criteria for severe CAP ICU: antibiotic first dose administered in ED No pathogen defined or tests pending: • β-Lactam + advanced macrolide 2 OR • Respiratory fluoroquinolone (Table 4) No pathogen defined or tests pending (Pseudomonas infection not an issue): • β-Lactam + advanced macrolide OR • β-Lactam + respiratory fluoroquinolone (Table 4) *Compatible clinical features include but are not limited to fever, hypothermia, rigors, sweats, new cough with/without sputum production, change in color of secretions, chest discomfort, or onset of dyspnea.

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