Lower respiratory tract infection and pneumonia in the community

Abstract

Community-acquired pneumonia (CAP) is common. There is no entirely satisfactory way of defining pneumonia using clinical criteria alone. New focal chest signs on examination in the presence of a systemic illness that is suggestive of a lower respiratory tract infection seems to be the best clinical finding that indicates pneumonia. Progress has been made in identifying simple clinical features that relate to prognosis and allow the general practitioner to decide whether care in the community is appropriate or hospital referral is required. Psychosocial factors for the patient will also remain important. Most patients who have CAP that is mild enough to be managed in the community will require few, if any, investigations. A chest radiograph is appropriate in all patients to exclude an underlying lung tumor. Measurement of surrogate markers of acute infection, such as C-reactive protein, may prove useful to the general practitioner if near testing were to become feasible. The antibiotic management for CAP for patients well enough to be managed at home can be simple and logical, providing general practitioners have some knowledge regarding likely pathogens and etiologic and epidemiological clues. Any antibiotic chosen must suppress Streptococcus pneumoniae, which remains the most common cause of CAP.