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Published by American Thoracic Society · GRADE
Understanding of the diagnosis and treatment of adults with community-acquired pneumonia (CAP) has evolved. This document updates evidence-based clinical practice guidelines on four key questions: LUS versus chest radiography, empiric antibacterial therapy with positive respiratory virus testing, antibiotic duration, and systemic corticosteroids.
Key Takeaways
Updates the 2019 guidelines by answering two new clinical questions (lung ultrasound vs. chest radiography, and empiric antibiotics for viral pneumonia) and updating two existing clinical questions (duration of antibiotics, and use of systemic corticosteroids).
For adults with suspected CAP, we suggest lung ultrasound is an acceptable diagnostic alternative to chest radiography in medical centers where appropriate clinical expertise exists.
For adult outpatients without comorbidities who have clinical and imaging evidence of CAP and who have a positive test result for a respiratory virus, we suggest not prescribing empiric antibiotics.
For adult outpatients with comorbidities who have clinical and imaging evidence of CAP and who have a positive test result for a respiratory virus, we suggest prescribing empiric antibiotics because of concern for bacterial-viral coinfection.
For adult inpatients with clinical and imaging evidence of nonsevere CAP who have a positive test result for a respiratory virus, we suggest prescribing empiric antibiotics because of concern for bacterial-viral coinfection.
For adult inpatients with clinical and imaging evidence of severe CAP who have a positive test result for a respiratory virus, we suggest prescribing empiric antibiotics because of concern for bacterial-viral coinfection.
For adult outpatients with CAP who reach clinical stability, we suggest less than 5 days of antibiotics (minimum of 3-d duration) rather than 5 or more days of antibiotics.
For adult inpatients with nonsevere CAP who reach clinical stability, we suggest less than 5 days of antibiotics (minimum of 3-d duration) rather than 5 or more days of antibiotics.
For adult inpatients with severe CAP who reach clinical stability, we suggest 5 or more days of antibiotics rather than less than 5 days of antibiotics.
For adult inpatients with nonsevere CAP, we recommend NOT administering systemic corticosteroids.
For adult inpatients with severe CAP, we suggest systemic corticosteroids.
Clinical Topic
Community-acquired Pneumonia
Objectives
To update evidence-based clinical practice guidelines on four key questions for the diagnosis and management of adult patients with CAP.
Target Patient Population
Adults with suspected or confirmed community-acquired pneumonia (CAP)
Diagnostic Criteria
Clinical signs and symptoms plus chest imaging confirmation to visualize alveolar inflammation
Target Providers
Therapeutic Area
Respiratory InfectionsGuideline Scope
Inclusion Criteria
Exclusion Criteria
Care Settings
Special Populations
System: GRADE
Recommendation Strength
Contraindications
Monitoring Guidance
Daily evaluations of clinical stability and review of microbiological results to inform deescalation or early discontinuation of antibacterial therapy.
Difficulty
advanced
Learning Paths