← Diagnosis and Management Guides
Community-Acquired Pneumonia
Key considerations: Sepsis, Empyema, Lung abscess
Cannot miss
- Sepsis
- Empyema
- Lung abscess
- TB
Likely diagnoses
- Bacterial CAP
- Viral pneumonia
- Atypical pneumonia
Red flags
- Septic shock
- Multilobar infiltrates
- Immunocompromised
- Parapneumonic effusion
Workup
- history: Cough, fever, dyspnea, pleurisy, sick contacts; exam: Crackles, egophony, dullness to percussion; labs: CBC, BMP, procalcitonin, blood cultures if admitted, sputum culture; imaging: CXR (PA/lateral); CT if CXR indeterminate; bedside: Lung ultrasound: consolidation, dynamic air bronchograms
Management
- immediate: Antibiotics within 4 hours of diagnosis; general: Outpatient: amoxicillin or doxycycline; Inpatient: ceftriaxone + azithromycin or respiratory fluoroquinolone; ICU: ceftriaxone + azithromycin (or FQ) ± vancomycin if MRSA risk
Disposition
- admit: CURB-65 ≥2, PSI class IV-V, hypoxia, unable to tolerate PO; discharge: CURB-65 0-1 with adequate home support; consults: Pulmonology for complicated effusion, ID for unusual organisms
Clinical pearls
- Procalcitonin <0.25 suggests viral etiology and may guide antibiotic de-escalation
- Switch to PO antibiotics when clinically improving, afebrile >24hr, tolerating PO
Source and review
- ATS/IDSA CAP Guidelines 2019. Last reviewed: 2024-11-01