Community-Acquired Pneumonia in Urgent Care Medicine (Pharmacology CME and Infectious Disease CME)

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Delivery Method:	Online
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Publication Date: April 2023 (Volume 2, Number 4)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 04/01/2026.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology and 4 Infectious Disease CME credits, subject to your state and institutional requirements.

Urgent Care Update Author

Peer Reviewers

Charting & Coding Author

h3 class="issue3 pt-3"> Abstract

Recommendations for the diagnosis, treatment, and disposition of patients with community-acquired pneumonia continue to evolve. This issue reviews the current evidence and guidelines for managing these patients in the urgent care setting, including key physical examination findings, diagnostic studies, and treatment options. Various clinical decision aids are compared in the context of their utility in outpatient facilities. A clinical pathway for urgent care management of community-acquired pneumonia is provided to help guide disposition decision making and delineate optimal antibiotic regimens based on patient comorbidities and risk factors.

Case Presentations

A 30-year-old man with no significant past medical history presents to the urgent care clinic with 2 days of fever, cough productive of green sputum, and malaise...

• Physical examination reveals left-sided rhonchi that do not clear with coughing.
• The patient has a heart rate of 105 beats/min and a temperature of 39.1°C. He is normotensive, has a respiratory rate of 22 breaths/min, is speaking in full sentences, and has 95% oxygen saturation on room air.
• COVID-19 rapid PCR, influenza A virus, and influenza B virus testing are all negative.
• X-rays show a left-sided retrocardiac opacity concerning for pneumonia.
• When you suggest to the patient that he may require treatment in a hospital, he states he would prefer to go home…

An 82-year-old woman with a history of mild COPD presents from an assisted-living facility with 3 days of mild cough productive of yellow sputum...

She reports no fever, chills, chest pain, shortness of breath, orthopnea, or paroxysmal nocturnal dyspnea.

Her physical examination reveals normal vital signs and slightly diminished breath sounds in the right lung fields. X-rays show a right-sided infiltrate consistent with pneumonia.

The patient’s daughter is concerned about the risk for an adverse outcome, but the patient says she would like to return to her assisted living facility...

A 55-year-old man with a history of diabetes mellitus and chronic kidney disease presents with 3 days of a nonproductive cough, fever, and lethargy...

• He is in moderate distress, is breathing with accessory muscles, and has rhonchi and rales in all lung fields.
• The patient is febrile and has a heart rate of 130 beats/min. His initial blood pressure is 88/50 mm Hg and his respiratory rate is 26 breaths/min. His oxygen saturation is at 88% on room air.
• X-ray findings include bilateral infiltrates concerning for multifocal pneumonia and a left-sided pleural effusion.
• The patient’s wife states she will bring him to the hospital after she goes home, packs the patient a bag, and lets the dog outside...

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.