how to manage a CAP in primary care

Community-based primary care management of community-acquired pneumonia (CAP) involves the following key steps:

• Diagnosis and severity assessment: Make a clinical diagnosis based on symptoms and signs of lower respiratory tract infection, using the CRB65 score to assess mortality risk and severity. A CRB65 score of 0 indicates low risk suitable for home care; scores of 1 or 2 require shared decision-making about hospital referral or supported community care; scores of 3 or 4 indicate high risk and need hospital assessment ².
• Antibiotic treatment: Start antibiotic treatment as soon as possible after diagnosis, ideally within 4 hours, or within 1 hour if sepsis is suspected ¹. For low-severity CAP, oral amoxicillin 500 mg three times daily for 5 days is first-line. If penicillin allergy or atypical pathogens are suspected, doxycycline or clarithromycin are alternatives. For moderate severity managed in the community, amoxicillin plus clarithromycin or erythromycin (in pregnancy) is recommended ¹.
• Symptom management and advice: Do not routinely use over-the-counter cough suppressants as evidence of benefit is lacking ¹. Advise patients that symptoms improve gradually: fever resolves by 1 week, chest pain and sputum reduce by 4 weeks, cough and breathlessness improve by 6 weeks, and most symptoms resolve by 3 months, though fatigue may persist longer ².
• Follow-up and safety netting: Advise patients to seek medical advice if symptoms worsen rapidly, do not improve after 3 days, or if they become systemically unwell ¹. Consider arranging a chest X-ray after 6 weeks if symptoms persist or if the patient is at higher risk of malignancy (e.g., smokers, age >50) ¹.
• Additional considerations: Encourage smoking cessation and consider pneumococcal and influenza immunizations after recovery ¹.