BTS guidelines for the management of community acquired pneumonia in adults: update 2009
- W S Lim,
- S V Baudouin,
- R C George,
- A T Hill,
- C Jamieson,
- I Le Jeune,
- J T Macfarlane,
- R C Read,
- H J Roberts,
- M L Levy,
- M Wani,
- M A Woodhead
- 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.
Hospital management of community acquired pneumonia (CAP) in the first 4 h. CXR, chest x ray; DBP, diastolic blood pressure; SBP, systolic blood pressure.
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Recommendations for the microbiological investigation of community acquired pneumonia (CAP)
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Initial empirical treatment regimens for community acquired pneumonia (CAP) in adults
Investigations (Section 5)
When should a chest radiograph be performed in the community?
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It is not necessary to perform a chest radiograph in patients with suspected CAP unless:
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The diagnosis is in doubt and a chest radiograph will help in a differential diagnosis and management of the acute illness. [D]
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Progress following treatment for suspected CAP is not satisfactory at review. [D]
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The patient is considered at risk of underlying lung pathology such as lung cancer. [D]
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When should a chest radiograph be performed in hospital?
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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?
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The chest radiograph need not be repeated prior to hospital discharge in those who have made a satisfactory clinical recovery from CAP. [D]
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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]
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Further investigations which may include bronchoscopy should be considered in patients with persisting signs, symptoms …
