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.
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...
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Following are the most informative references cited in this paper, as determined by the authors.
3. * 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
7. * Metlay JP, Waterer GW. Treatment of community-acquired pneumonia during the coronavirus disease 2019 (COVID-19) pandemic. Ann Intern Med. 2020;173(4):304-305. (Guideline) DOI: 10.7326/M20-2189
13. * Jain S, Self WH, Wunderink RG, et al. Community-acquired peumonia requiring hopitalization among U.S. adults. N Engl J Med. 2015;373(5):415-427. (Prospective; 2400 patients) DOI: 10.1056/NEJMoa1405870
23. * 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). (Prospective; 28,883 patients) DOI: 10.1183/13993003.00434-2017
32. Hicks J. Point of care ultrasound (POCUS) in urgent care. The Journal of Urgent Care Medicine. Accessed March 10, 2023. (Online review article)
48. * Bauer TT, Ewig S, Marre R, et al. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006;260(1):93-101. (Multicenter prospective study; 1343 patients) DOI: 10.1111/j.1365-2796.2006.01657.x
49. * Ebell MH, Walsh ME, Fahey T, et al. Meta-analysis of calibration, discrimination, and stratum-specific likelihood ratios for the CRB-65 score. J Gen Intern Med. 2019;34(7):1304-1313. (Meta-analysis; 29 studies) DOI: 10.1007/s11606-019-04869-z
51. * Pakhale S, Mulpuru S, Verheij TJ, et al. Antibiotics for community-acquired pneumonia in adult outpatients. Cochrane Database Syst Rev. 2014;2014(10):CD002109. (Cochrane review; 11 randomized controlled trials, 3352 participants) DOI: 10.1002/14651858.CD002109.pub4
58. Tepler P, Zehtabchi S. Corticosteroids for treating pneumonia. The NNT. Updated March 29, 2019. Accessed March 10, 2023. (Online review article)
62. Rezaie S. The Tamiflu debacle. REBEL EM - Emergency Medicine Blog. October 24, 2018. Accessed March 10, 2023. (Online review article)
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Keywords: community-acquired pneumonia, CAP, COVID-19, influenza, Streptococcus, Mycoplasma, Pseudomonas, upper respiratory infection, cough, fever, chills, fatigue, culture, testing, CURB-65, CRB-65, PSI, antibiotics, antitussive, corticosteroids
Keith Pochick, MD, FACEP: Editor-in-Chief Tracey Quail Davidoff, MD, FCUCM: Update Author
Nichele Nivens, MD, FAAFP, FCUCM
Brad Laymon, PA-C, CPC, CEMC
April 1, 2023
April 1, 2026   CME Information
4 AMA PRA Category 1 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 1 Pharmacology and 4 Infectious Disease CME credits