Management of community-acquired pneumonia: essential tips for the physician on call

Abstract

Community-acquired pneumonia is a common clinical problem requiring admission to hospital, with a particularly high incidence in the elderly population and those with significant comorbidities. Diagnosis is made on the combination of a short history of respiratory symptoms and systemic ill-health with new examination and/or radiological features of consolidation. Multiple other infective and non-infective conditions can mimic community-acquired pneumonia, leading to misdiagnosis in 5–17% of cases. The CURB-65 score can identify patients with community-acquired pneumonia with a higher risk of mortality, but is insensitive at identifying patients requiring intensive care support and needs to be combined with clinical markers of potential severity. Both high admission levels of C-reactive protein and the failure of levels of C-reactive protein to decline by >50% by day 4 after admission are associated with higher risk of complications, need for ventilation or inotropic support, and mortality. Empirical antibiotic therapy for most patients admitted to hospital is combination of a ß-lactam and a macrolide. Short courses of antibiotics do not result in significantly different outcomes to longer courses unless the patient has developed complications such as a complex parapneumonic effusion. Implementation of a community-acquired pneumonia care bundle into clinical practice reduces mortality, and should be a high priority for all acute hospitals.

Comment on “Are erythema multiforme and urticaria related to a better outcome of COVID 19?” Eosinophil count in seven patients with COVID ‐19 and urticarial rash

“…CURB-65 is a five-point score, commonly used in the emergency department to stratify the mortality risk and improve management of patients with pneumonia. 4 Although the low number of patients prevented a statistical analysis, we did not find that eosinophilia was related to a lower CURB-65 score in patients with an urticarial rash. Conversely, eosinophilia was present in two patients with a CURB-65 score of 1, while the two patients with the lower CURB-65 (score 0) did have eosinopenia (Table 1).…”