Fluoroquinolones in the Management of Community-acquired Pneumonia in Primary Care

Brian Wispelwey; Katherine R Schafer

Disclosures

Expert Rev Anti Infect Ther. 2010;8(11):1259-1271. 

In This Article

Diagnosis & Diagnostic Testing

Among patients seen in the primary care setting, bacterial CAP is commonly identified by a sudden onset of cough with production of purulent sputum, dyspnea, tachypnea, tachycardia and pleuritic chest pain, and may present with an ill appearance, fever, fatigue, abnormal breath sounds and crackles. By contrast, viral CAP generally has a different presentation: the onset of illness is usually gradual, cough is nonproductive, wheezing is usually present, the patient often has a low-grade temperature (<101.3°F), and it occurs more often in the fall or winter.[2,25] Diagnostic testing includes chest radiograph, sputum culture, Gram stain, blood test and blood cultures.[1,2]

In outpatients, disease severity should be carefully assessed by radiograph and physical findings, but sputum culture and Gram stain are not required in this patient population unless a drug-resistant pathogen is suspected.[2] Patients admitted to the hospital should have blood-gas analyses with pulse oximetry or with arterial blood gas in patients with severe disease. A complete blood count, differential, routine blood chemistry and blood culture should be carried out. If a drug-resistant pathogen is suspected, a sputum culture should be obtained. In patients admitted to the ICU with severe CAP, blood culture, sputum culture and urinary antigen tests for Legionella pneumophila and S. pneumoniae should be performed.[1,2]

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