What are the Infectious Diseases Society of America (IDSA) guidelines for chest radiology in the diagnosis of viral pneumonia?

Updated: Mar 24, 2021
  • Author: Zab Mosenifar, MD, FACP, FCCP; Chief Editor: John J Oppenheimer, MD  more...
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No firm guidelines exist for when to obtain a chest radiograph in patients to aid in diagnosing lower respiratory tract infection. Chest pain, dyspnea, and productive cough are some of the indications used by clinicians.

The Infectious Diseases Society of America recommends chest radiography to confirm infiltrates when pneumonia is suspected for the following reasons: the severity of disease may be revealed, detection of pneumonia may not be possible on purely clinical grounds, and antibiotics are not useful for treatment of bronchitis. It is recommended that a chest radiograph be obtained in patients with suspected pneumonia, both to find complications, such as pleural effusions, and to discourage the use of antibiotics in healthy patients with bronchitis rather than pneumonia.

Antibiotics are recommended for pneumonia, and a chest radiograph is necessary to make this diagnosis. Antibiotics have not been shown to be efficacious in bronchitis. The widespread use of antibiotics in inappropriate situations is leading to drug resistance and may explain the increases in death rates since 1979. Antibiotics can cause adverse drug reactions. Thus, antibiotics should be avoided when they are not needed. However, if an infiltrate is seen on a chest radiograph, it may be due to viral or bacterial disease or both. In the ED, differentiating the etiology may be impossible.

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