Community-Acquired Pneumonia Management

Patient Assessment and Stratification

The American Thoracic Society recommends assessing severity of illness to determine appropriate outpatient management using validated tools such as the Pneumonia PORT severity index or CURB-65 2, 3
Patients in risk classes I-II of the Pneumonia PORT or with CURB-65 scores of 0-1 are generally appropriate for outpatient management 2

The American College of Chest Physicians recommends amoxicillin 1g three times daily for healthy adults without comorbidities (strong recommendation) 1
The American College of Chest Physicians recommends doxycycline 100mg twice daily for healthy adults without comorbidities (conditional recommendation) 1
The American College of Chest Physicians recommends combination therapy (amoxicillin/clavulanate plus a macrolide or doxycycline) for adults with comorbidities 1
The American College of Chest Physicians recommends monotherapy with a respiratory fluoroquinolone (levofloxacin, moxifloxacin, or gemifloxacin) as an alternative for adults with comorbidities 1

The Infectious Diseases Society of America recommends a minimum of 5 days of antibiotic therapy 3, 1
The British Thoracic Society recommends clinical review at around 6 weeks and a follow-up chest radiograph for patients with persistent symptoms or physical signs 4, 5

The British Thoracic Society recommends conducting a careful review of clinical history, examination, and investigation results if a patient fails to improve as expected 4
The British Thoracic Society recommends considering additional investigations, including repeat chest radiograph, CRP, white cell count, and further microbiological testing, for patients not responding to initial therapy 4

The Infectious Diseases Society of America recommends avoiding underestimation of severity of illness, which may lead to inappropriate outpatient management 2, 3
The American College of Chest Physicians recommends avoiding macrolide monotherapy in areas with high pneumococcal resistance 1
The Infectious Diseases Society of America recommends avoiding inadequate duration of therapy (less than 5 days) 3, 1
The British Thoracic Society recommends avoiding overuse of fluoroquinolones as first-line agents, which should be reserved for specific situations 4, 5