Lower respiratory tract infections and adult CAP in primary care

Diagnosing community-acquired pneumonia within time-pressured consultations in primary care is challenging. The traditional tools of history and examination poorly predict the presence of radiographic pneumonia. Point-of-care testing with biomarkers, such as C-reactive protein, is feasible andcost-effective,andmayhelpclinicianstobettertarget antibiotic prescription to those who will receive meaningful benefit, thus limiting overuse in those who are unlikely to benefit. Widespread use of antibiotics in primary care for respiratory tract infections is driving antimicrobial resistance and strategies, e.g. the use of enhanced communication skills by clinicians has proved effective in safely reducing antibiotic prescribing. Most patients with community-acquired pneumonia can be successfully managed in the community, with antibiotics prescribed according to national guidelines. Assessment of patients who require referral to secondary care can be aided by using severity of illness tools, such as CRB65 (confusion, respiratory rate ≥30 breaths min-1, blood pressure <90 mmHg (systolic) or ≤60 mmHg (diastolic), age ≥65 years), which measure perturbations in simple physiological measures and antibiotic treatment targeted accordingly. © 2014.