Management of Community-Acquired Pneumonia

A 65-year old man with hypertension and degenerative joint disease presents to the emergency department with a three-day history of a productive cough and fever. His temperature is 38.3°C (101°F), his blood pressure is 144/92 mm Hg, his respiratory rate is 22 breaths per minute, his heart rate is 90 beats per minute, and his oxygen saturation is 92 percent while he is breathing room air. Physical examination reveals only crackles and egophony in the right lower lung field. The white-cell count is 14,000 per cubic millimeter, and routine chemical tests are normal. A chest radiograph shows an infiltrate in the right lower lobe. How should this patient be treated? Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage A 65-year-old man with hypertension and degenerative joint disease presents to the emergency department with a three-day history of a productive cough and fever. He has a temperature of 38.3°C (101°F), a blood pressure of 144/92 mm Hg, a respiratory rate of 22 breaths per minute, a heart rate of 90 beats per minute, and oxygen saturation of 92 percent while breathing room air. Physical examination reveals only crackles and egophony in the right lower lung field. The white-cell count is 14,000 per cubic millimeter, and the results of routine chemical tests are normal. A chest radiograph shows an . . .