As 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 emergency department. The various clinical decision aids are compared, as they assist in determining the level of inpatient care required and allow for a greater proportion of patients to be treated successfully as outpatients. A clinical pathway for emergency department management delineates optimal antibiotic regimens based on severity, comorbidities, and risk factors.
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Following are the most informative references cited in this paper, as determined by the authors.
12. * Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-427. (Prospective; 2400 patients) DOI: 10.1056/NEJMoa1500245
21. * Moore M, Stuart B, Little P, et al. Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study. Eur Respir J. 2017;50(5):1700434. (Prospective; 28,883 patients) DOI: 10.1183/13993003.00434-2017
38. * Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. (Guideline) DOI: 10.1164/rccm.201908-1581ST
47. * Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243-250. (Retrospective; 14,199 patients) DOI: 10.1056/NEJM199701233360402
59. * Pakhale S, Mulpuru S, Verheij TJM, et al. Antibiotics for community-acquired pneumonia in adult outpatients. Cochrane Database Syst Rev. 2014(10):CD002109. (Cochrane review; 11 randomized controlled trials, 3352 participants) DOI: 10.1002/14651858.CD002109.pub4
75. Walker G. Corticosteroids for treating pneumonia. The NNT 2019. Accessed December 9, 2019. (Website)
79. Rezaie S. The Tamiflu debacle. REBEL EM - Emergency Medicine Blog 2019. Accessed January 10, 2021. (Website)
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Keywords: community-acquired pneumonia, COVID-19, Streptococcus, Mycoplasma, Pseudomonas, upper respiratory infection, cough, fever, chills, fatigue, biomarkers, culture, testing, CURB-65, PSI, severity index, SMART-COP, antibiotics, antitussive, pediatric, corticosteroids, influenza
Matthew DeLaney, MD, FACEP, FAAEM; Charles Khoury, MD, MSHA, FACEP
Daniel J. Egan, MD; Benjamin Christian Renne, MD
February 1, 2021
February 1, 2024   CME Information
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits
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+4 Credits!
Matthew DeLaney, MD, FACEP, FAAEM; Charles Khoury, MD, MSHA, FACEP
Daniel J. Egan, MD; Benjamin Christian Renne, MD
February 1, 2021
February 1, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits
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Urgent Care Diagnosis and Management of Urinary Tract Infections in Adults
Pediatric Influenza in the Emergency Department: Diagnosis and Management (Infectious Disease CME)