Most patients do not require monitoring. An alternative diagnosis should be considered when symptoms persist beyond 2 weeks. A chest x-ray should be sought if a cough persists beyond 4 weeks. If complications such as otitis media or sinusitis have resulted from previous episodes, extra surveillance may be warranted. When there is a history of COPD or previous pneumonia, a higher degree of vigilance may be required for superimposed infections and more serious complications such as lung cancer. A patient with fever, tachycardia and hypotension, and/or neck stiffness warrants immediate referral to the hospital and/or parenteral antibiotics for suspected meningococcal septicemia.
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