Volume 19 Issue 1 March 2010
| Guideline Summary |
Primary care summary of the British Thoracic Society Guidelines for the management of community acquired pneumonia in adults: 2009 update
Endorsed by the Royal College of General Practitioners and the Primary Care Respiratory Society UK
Pages 21-27
Mark L Levya, Ivan Le Jeuneb, Mark A Woodheadc, John T Macfarlanedd, *Wei Shen Limd, on behalf of the British Thoracic Society Community Acquired Pneumonia in Adults Guideline GroupZ
a Senior Clinical Research Fellow, Allergy & Respiratory Research Group, Division of Community Health Sciences:GP Section, University of Edinburgh, Scotland, UK
b Departments of Acute and Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
c Department of Respiratory Medicine, Manchester Royal Infirmary, Manchester, UK
d Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
Received 11 January 2009 • Accepted 1 February 2010 • Online 15 February 2010
Abstract
INTRODUCTION: The identification and management of adults presenting with pneumonia is a major challenge for primary care health professionals. This paper summarises the key recommendations of the British Thoracic Society (BTS) Guidelines for the management of Community Acquired Pneumonia (CAP) in adults. METHOD: Systematic electronic database searches were conducted in order to identify potentially relevant studies that might inform guideline recommendations. Generic study appraisal checklists and an evidence grading from A+ to D were used to indicate the strength of the evidence upon which recommendations were made. CONCLUSIONS: This paper provides definitions, key messages, and recommendations for handling the uncertainty surrounding the clinical diagnosis, assessing severity, management, and follow-up of patients with CAP in the community setting. Diagnosis and decision on hospital referral in primary care is based on clinical judgement and the CRB-65 score. Unlike some other respiratory infections (e.g. acute bronchitis) an antibiotic is always indicated when a clinical diagnosis of pneumonia is made. Timing of initial review will be determined by disease severity. When there is a delay in symptom or radiographic resolution beyond six weeks, the main concern is whether the CAP was a complication of an underlying condition such as lung cancer.
Cite as: Levy ML, Le Jeune I, Woodhead MA, Macfarlaned JT, Lim WS, on behalf of the British Thoracic Society Community Acquired Pneumonia in Adults Guideline Group. Primary care summary of the British Thoracic Society Guidelines for the management of community acquired pneumonia in adults: 2009 update. Prim Care Respir J 2010;19(1):21-27. DOI: http://dx.doi.org/10.4104/pcrj.2010.00014
Keywords
Community acquired pneumonia, primary care, guideline, adults, diagnosis, severity, management, CRB-65 score, treatment, follow-up
* Corresponding author. Wei Shen Lim Tel: +44 (0)115 969 1169 ext 59347 Fax: +44 (0)115 962 7723 Email: weishen.lim@nuh.nhs.uk