Review of adults with high-severity CAP

Once treatment for high-severity CAP has started, the patient’s symptoms should steadily improve. The rate of recovery is influenced by the severity of pneumonia and the patient’s general health and comorbidities. Fever should subside within the first few days of appropriate antibiotic therapy and appetite should improve. Cough, sputum production (if present), chest discomfort and breathlessness may take several weeks to resolve and are often due to exacerbations of comorbidities (eg heart failure). Patients can report fatigue for months after an episode of pneumonia. Prolonged symptoms are not an indication for extended antibiotic therapy.

If the response to initial empirical therapy is inadequate at 48 hours, reassess the patient’s prognosis and diagnosis, and consider infective and noninfective diagnoses – see Approach to managing adults with CAP who are not improving. Modify treatment based on the results of investigations, including susceptibility testing – see Directed therapy for pneumonia or, if Burkholderia pseudomallei pneumonia is confirmed, Melioidosis.