BTS Guidelines for the Management of Community Acquired Pneumonia in Adults
- British Thoracic Society Standards of Care Committee in collaboration with and endorsed by the Royal College of Physicians of London, Royal College of General Practitioners, British Geriatrics Society, British Lung Foundation, British Infection Society, British Society for Antimicrobial Chemotherapy, and Public Health Laboratory Service
- Dr J Macfarlane, Respiratory Medicine Unit, Medical Research Centre Building, Nottingham City Hospital, Nottingham NG5 1PB, UK.
Synopsis
Scope of these guidelines (sections 1.1–1.7)
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These guidelines refer to the management of adults with community acquired pneumonia (CAP) of all ages in the community or in hospital. They have been developed to apply to the UK healthcare system and population, but they should equally be applicable to any other countries which operate similar healthcare services.
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They are not aimed at patients with known predisposing conditions such as cancer or immunosuppression admitted with pneumonia to specialist units such as oncology, haematology, palliative care, infectious diseases units, or AIDS units.
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They do NOT apply to the much larger group of adults with non-pneumonic lower respiratory tract infection, including illnesses labelled as acute bronchitis, acute exacerbations of chronic obstructive pulmonary disease (COPD), or “chest infections”.
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Details of methods, the level of evidence, and grading of recommendations are given in the text (sections 1.8–1.15) and appendices and are summarised briefly for easy reference in table 1.
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Brief description of the generic levels of evidence and guideline statement grades used1-150
Synopsis of main summary points
aetiology and epidemiology (section 3)
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Only a small range of pathogens causes CAP, with Streptococcus pneumoniae being the most frequent (tables 2-6, fig 3) [Ib].
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The frequency of pathogens can vary in specific patient groups. Mycoplasma and legionella infections are less frequent in the elderly (box 1, fig 5) [Ib].
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The low frequency of legionella, staphylococcal, Chlamydia psittaci and Coxiella burnetii infection in patients with CAP, together with the likely high frequency of the relevant epidemiological risk factors in the general population (for example, recent travel or contact with someone with an influenza type disease) suggests that routine enquiry about such factors is likely to be misleading [IV].
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Only in those with severe illness, where the frequency of legionella and staphylococcal infection is higher, may enquiry …
