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Thorax 64:iii1-iii55 doi:10.1136/thx.2009.121434
  • BTS guidelines

BTS guidelines for the management of community acquired pneumonia in adults: update 2009

  1. W S Lim,
  2. S V Baudouin,
  3. R C George,
  4. A T Hill,
  5. C Jamieson,
  6. I Le Jeune,
  7. J T Macfarlane,
  8. R C Read,
  9. H J Roberts,
  10. M L Levy,
  11. M Wani,
  12. M A Woodhead
  1. Correspondence to Dr W S Lim, Respiratory Medicine, Nottingham University Hospitals, David Evans Building, Hucknall Road, Nottingham NG5 1PB, UK; weishen.lim{at}nuh.nhs.uk
  • Received 11 June 2009
  • Accepted 6 July 2009

Synopsis of recommendations

A summary of the initial management of patients admitted to hospital with suspected community acquired pneumonia (CAP) is presented in fig 8. Tables 4 and 5, respectively, summarise (1) the relevant microbiological investigations and (2) empirical antibiotic choices recommended in patients with CAP.

Figure 8

Hospital management of community acquired pneumonia (CAP) in the first 4 h. CXR, chest x ray; DBP, diastolic blood pressure; SBP, systolic blood pressure.

View this table:
Table 4

Recommendations for the microbiological investigation of community acquired pneumonia (CAP)

View this table:
Table 5

Initial empirical treatment regimens for community acquired pneumonia (CAP) in adults

Investigations (Section 5)

When should a chest radiograph be performed in the community?

  1. It is not necessary to perform a chest radiograph in patients with suspected CAP unless:

    • The diagnosis is in doubt and a chest radiograph will help in a differential diagnosis and management of the acute illness. [D]

    • Progress following treatment for suspected CAP is not satisfactory at review. [D]

    • The patient is considered at risk of underlying lung pathology such as lung cancer. [D]

When should a chest radiograph be performed in hospital?

  1. All patients admitted to hospital with suspected CAP should have a chest radiograph performed as soon as possible to confirm or refute the diagnosis. [D] The objective of any service should be for the chest radiograph to be performed in time for antibiotics to be administered within 4 h of presentation to hospital should the diagnosis of CAP be confirmed.

When should the chest radiograph be repeated during recovery?

  1. The chest radiograph need not be repeated prior to hospital discharge in those who have made a satisfactory clinical recovery from CAP. [D]

  2. A chest radiograph should be arranged after about 6 weeks for all those patients who have persistence of symptoms or physical signs or who are at higher risk of underlying malignancy (especially smokers and those aged >50 years) whether or not they have been admitted to hospital. [D]

  3. Further investigations which may include bronchoscopy should be considered in patients with persisting signs, symptoms …