Abstract
Background: Patients commonly present to primary care services with upper and lower respiratory tract infections, and guidelines to help physicians investigate and treat acute cough due to suspected pneumonia and influenza are needed.
Methods: A systematic search was carried out with eight patient,
intervention, comparison, outcome questions related to acute cough due to
suspected pneumonia or influenza.
Results: There was a lack of randomized controlled trials in the
setting of outpatients presenting with acute cough due to suspected pneumonia
or influenza who were not hospitalized. Both clinical suggestions and research
recommendations were made on the evidence available and CHEST Expert Cough
Panel advice.
Conclusions: For outpatient adults with acute cough due to suspected
pneumonia, we suggest the following clinical symptoms and signs are suggestive
of pneumonia: cough; dyspnea; pleural pain; sweating, fevers, or shivers; aches
and pains; temperature ≥ 38°C; tachypnea; and new and localizing chest
examination signs. Those suspected of having pneumonia should undergo chest
radiography to improve diagnostic accuracy. Although the measurement of
C-reactive protein levels strengthens both the diagnosis and exclusion of
pneumonia, there was no added benefit of measuring procalcitonin levels in this
setting. We suggest that there is no need for routine microbiological testing.
We suggest the use of empiric antibiotics according to local and national
guidelines when pneumonia is suspected in settings in which imaging cannot be
performed. Where there is no clinical or radiographic evidence of pneumonia, we
do not suggest the routine use of antibiotics. There is insufficient evidence
to make recommendations for or against specific nonantibiotic, symptomatic
therapies. Finally, for outpatient adults with acute cough and suspected
influenza, we suggest that initiating antiviral treatment (according to Centers
for Disease Control and Prevention advice) within 48 hours of symptoms could be
associated with decreased antibiotic use and hospitalization and improved
outcomes.
Original language | English |
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Pages (from-to) | 155-167 |
Number of pages | 13 |
Journal | Chest |
Volume | 55 |
Issue number | 1 |
Early online date | 6 Oct 2018 |
DOIs | |
Publication status | Published - Jan 2019 |
Externally published | Yes |