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) Manage as outpatient
Empirical therapy (Table 4)
(eg, frail condition, no response to oral therapy, severe social or psychiatric problems, substance abuse, unstable living situation, homelessness)
Mitigating factors
Refer to Table 3 for clinical indications for more extensive diagnostic testing
General medical ward: antibiotic first dose administered in ED
(PSI risk classes III, IV, V;
Hospitalize patient CURB-65 score ≥ 2)
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 OR
2 • 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.
