Community-acquired pneumonia: Tailoring management of adult patients according to risk category

A cost-conscious evaluation of CAP in the adult patient requires an initial assessment of the clinical severity and the risks of complicated pneumonia. Initially, most patients should have chest radiography; some authorities also recommend sputum Gram staining and culture, but additional blood testing, culture, and diagnostic procedures are indicated only for patients who have chronically impaired health or clinical evidence of severe infection. Initial empirical antibiotic therapy varies depending on the setting (outpatient, hospitalized patient, critically ill patient). Failure of the patient to respond to empirical antibiotic therapy within 72 hours should direct the clinician to consider unusual or resistant organisms or noninfectious causes of pneumonitis.