Review of patients with low- to moderate-severity HAP

Review patients with low- to moderate-severity HAP within 24 to 48 hours and reassess the diagnosis. If the response to initial empirical therapy is inadequate at 48 hours, consider infective and noninfective diagnoses (eg heart failure, aspiration pneumonitis) – see Approach to managing patients with HAP who are not improving. At 48 hours, if there is no strong evidence to support the diagnosis of HAP, stop antibiotic therapy.

Modify treatment based on the results of investigations, including susceptibility testing, if possible (see Directed therapy for pneumonia).

Once treatment for pneumonia 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 may report exertional fatigue for months after an episode of pneumonia due to deconditioning; however, its presence requires exclusion of other causes. Prolonged symptoms are not an indication for extended antibiotic therapy.