Community-Acquired Pneumonia in Adults

Background

The clinical spectrum of community-acquired pneumonia ranges from infections that can be treated on
an outpatient basis, with 1% mortality, to those that present as medical emergencies, with a mortality
above 40%.

Methods

This article is based on pertinent publications and current guidelines retrieved by a selective search of
the literature.

Results

The radiological demonstration of an infiltrate is required for the differentiation of pneumonia from
acute bronchitis regardless of whether the patient is seen in the outpatient setting or in the emergency
room. For risk prediction, it is recommended that the CRB-65 criteria, unstable comorbidities, and
oxygenation should be taken into account. Amoxicillin is the drug of choice for mild pneumonia; it should
be given in combination with clavulanic acid if there are any comorbid illnesses. The main clinical
concerns in the emergency room are the identification of acute organ dysfunction and the management
of sepsis. Intravenous beta-lactam antibiotics should be given initially, in combination with a macrolide if
acute organ dysfunction is present. The treatment should be continued for 5–7 days. Cardiovascular
complications worsen the patient’s prognosis and should be meticulously watched for. Structured follow-
up care includes the follow-up of comorbid conditions and the initiation of recommended preventive
measures such as antipneumococcal and anti-influenza vaccination, the avoidance of drugs that increase
the risk, smoking cessation, and treatment of dysphagia, if present.

Conclusion

Major considerations include appropriate risk stratification and the implementation of a management
strategy adapted to the degree of severity of the disease, along with the establishment of structured
follow-up care and secondary prevention, especially for patients with comorbidities.

References: Pletz MW, Rohde G, Schutte H, Bals R, von BH, Welte T. [Epidemiology and aetiology of
community-acquired pneumonia (CAP)] Dtsch Med Wochenschr. 2011;136:775–780. [PubMed] [Google
Scholar]