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Adult Outpatients with Acute Cough due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report

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  • Adult Outpatients with Acute Cough due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report

    Chest. 2018 Oct 5. pii: S0012-3692(18)32499-1. doi: 10.1016/j.chest.2018.09.016. [Epub ahead of print]
    Adult Outpatients with Acute Cough due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report.

    Hill AT1, Gold PM2, El Solh A3, Metlay JP4, Ireland B5, Irwin RS6; CHEST Expert Cough Panel.
    Author information

    Abstract

    BACKGROUND:

    Patients commonly present to primary care services with upper and lower respiratory tract infections and guidelines to help clinicians investigate and treat acute cough due to suspected pneumonia and influenza are needed.
    METHODS:

    A systematic search was carried out with eight PICO questions related to acute cough with 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 that were not hospitalized. Both clinical suggestions and research recommendations were made on the evidence available and CHEST Expert Cough Panel advice.
    CONCLUSIONS:

    We suggest for outpatient adults with acute cough due to suspected pneumonia, the following clinical symptoms and signs are suggestive of pneumonia (cough, dyspnea, pleural pain, sweating/fevers/shivers, aches and pains, temperature 38C or greater, tachypnea and new and localizing chest examination signs. Those suspected of having pneumonia, should have a chest radiograph to improve diagnostic accuracy. While the measurement of C-reactive protein strengthens both the diagnosis and exclusion of pneumonia, there was no added benefit of measuring procalcitonin in this setting. We suggest for outpatient adults with acute cough and suspected pneumonia, there is no need for routine microbiologic testing. For outpatient adults with acute cough, we suggest the use of empiric antibiotics as per local and national guidelines when pneumonia is suspected in settings where imaging cannot be obtained. Where there is no clinical or radiographic evidence of pneumonia, we suggest against the routine use of antibiotics. There is insufficient evidence to make recommendations for or against specific non-antibiotic symptomatic therapies. Finally, for outpatient adults with acute cough and suspected influenza, we suggest that initiating antiviral treatment (as per CDC advice) within 48 hours of symptoms could be associated with decreased antibiotic usage, hospitalization and improved outcomes.
    Copyright 2018. Published by Elsevier Inc.


    PMID: 30296418 DOI: 10.1016/j.chest.2018.09.016
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