Community-acquired pneumonia in adults (non COVID-19)

Community-acquired pneumonia (CAP) typically presents with symptoms and signs consistent with a lower respiratory tract infection (i.e., cough, dyspnoea, pleuritic chest pain, mucopurulent sputum, myalgia, fever) and no other explanation for the illness. Older people present more frequently with confusion or worsening of pre-existing conditions, and without chest signs or fever.

Confirm diagnosis in all patients presenting to hospital with evidence of consolidation (new shadowing that is not due to any other cause) on chest x-ray. A chest x-ray should not be requested routinely for patients managed in the community.

Use the CURB-65 mortality risk score (hospital setting) or CRB-65 severity score (community setting), together with your clinical judgement, to decide whether to manage the patient in hospital or at home and to determine appropriate therapy.

Initial treatment is with empirical antibiotics, following national/international guidelines and local epidemiology. In hospital, administer antibiotics within 4 hours of presentation.

Send sputum and blood samples for culture in people with moderate- or high-severity CAP, ideally before antibiotics are started, and consider legionella and pneumococcal urine antigen testing.

Give supplemental oxygen to patients with oxygen saturation <94% (or <88% in patients at risk of CO₂ retention).

Consider sepsis whenever an acutely unwell person presents with likely infection, even if their temperature is normal. Follow your local protocol for prompt management of all patients with suspected sepsis, or those at risk.

Community-acquired pneumonia (CAP) is defined as pneumonia acquired outside hospital or healthcare facilities. Clinical diagnosis is based on a group of signs and symptoms related to lower respiratory tract infection with presence of fever >38ºC (>100ºF), cough, mucopurulent sputum, pleuritic chest pain, dyspnoea, and new focal chest signs on examination such as crackles or bronchial breathing. Older patients present more frequently with confusion or worsening of pre-existing conditions, and without chest signs or fever.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55. https://thorax.bmj.com/content/64/Suppl_3/iii1.long http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com  

This topic focuses on the diagnosis and management of non-COVID-19 CAP in adults. For patients with suspected or confirmed COVID-19 pneumonia, see our topic Coronavirus disease 2019 (COVID-19) Opens in new window. Consider all patients with cough, fever, or other suggestive symptoms to have COVID-19 until proven otherwise. Pneumonia due to COVID-19 is not covered in this topic.