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.
