eMedinewS Editorial

4:56 am Health Care

The new British Thoracic Society guidelines for
Community–acquired pneumonia

Community–acquired pneumonia (CAP) is common and predominantly affects the old and very young. It accounts for 5–12% of all cases of LRTI managed in the community with 22–42% of these needing admission. Mortality of patients treated at home is low at 1% but up to 14% in those admitted to hospital. Symptoms depend on the causative organism but generally include high fever, acute onset, dry cough, dyspnea, pleuritic chest pain and flu–like general malaise. Comorbidities like COPD, left ventricular failure and non–specific symptoms in the elderly may complicate the clinical picture. The presence of localizing signs in the chest – crackles – is helpful in diagnosis.

Guidelines

  1. Chest X–ray is unnecessary in routine suspected CAP unless the diagnosis is in doubt; progress following treatment for CAP is not satisfactory at review and the patient is at risk of other pathologies such as lung cancer.
  2. Radiological resolution often lags behind clinical improvement, especially in the elderly.
  3. Sputum culture is not routinely required.
  4. One should assess severity using the CURB65 score.
    • Confusion: New mental confusion
    • Urea raised above 7mmol/l: In hospitalized patients
    • Respiratory rate: Raised, above 30 per minute
    • Blood pressure: Low (systolic < 90mmHg and/or diastolic < 60mmHg)
      The risk of death from pneumonia increases with higher scores.
  5. An oxygen saturation of less than 92% indicates more severe infection.
  6. Treatment in the community should be with antibiotics. Amoxycillin 500mg thrice daily for a week or doxycyline or clarithromycin as alternatives are recommended.

Dr KK Aggarwal
Editor in Chief

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