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2004 update of BTS pneumonia guidelines: what’s new?
  1. J T Macfarlane1,
  2. D Boldy2
  1. 1Chairman of the BTS Pneumonia Guidelines Committee, Nottingham City Hospital, Nottingham NG5 1PB, UK
  2. 2Chairman of the BTS Standards of Care Committee, Pilgrim Hospital, Boston PE21 9QS, UK
  1. Correspondence to:
    Dr J T Macfarlane
    Nottingham City Hospital Nottingham NG5 1PB, UK;

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

The BTS guidelines for the management of adult community acquired pneumonia (CAP), published in December 2001, assessed relevant evidence published up to 2000.1 An update summarising more recent available evidence up to 2003 has just been published on the BTS website ( using an identical search assessment and appraisal system. Minor additions or changes have been made in the sections on aetiology (related to nursing home acquired pneumonia), general investigations (use of C reactive protein and oximetry), general management, and vaccination strategies. The more important changes have been in the recommendations for the microbiological investigation of CAP, severity assessment, discharge planning, and antibiotics. At present these guidelines do not include information on severe acute respiratory syndrome (SARS), for which an updated specific guideline is available on the BTS website to help clinicians with case definition and management and will shortly be published in the Journal of Infection.


Microbiological investigation

Several studies have provided further evidence that the overall sensitivity of blood and sputum cultures in CAP is low, particularly for patients with non-severe CAP and no co-morbid disease and for those who have received antibiotic treatment before admission.2–5 This has led to a changed recommendation that blood cultures may be omitted in a patient with no severity indicators or co-morbid disease providing the diagnosis of CAP has been definitely confirmed. The latter condition is important, particularly when dealing with a febrile patient where the site of infection is not clear and blood cultures …

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