New CHEST Guideline for Acute Cough Suspicious of Pneumonia or Influenza

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Antibiotics should be prescribed in settings where imaging is not possible.
Antibiotics should be prescribed in settings where imaging is not possible.

The CHEST Expert Cough Panel, an international group of experts, released new recommendations for pneumonia and influenza treatments and diagnoses, and these suggestions were published in CHEST.

The panel developed 8 clinical questions and used a population, intervention, comparison, outcome (PICO) element table to reach their recommendations.

The Expert Cough Panel agreed on the following clinical symptoms as criteria suggestive of pneumonia in outpatient adults: cough, dyspnea, pleural pain, sweating, shivers, aches, temperature of ≥38°C, tachypnea, and new and localizing chest examination signs. They also recommended measuring C-reactive protein to help confirm or rule out pneumonia but not for measuring procalcitonin routinely.

If the outpatient has vital signs suggestive of pneumonia, the panel recommends a chest X-ray but routine microbiologic testing to be unnecessary. Antibiotics should be prescribed in settings where imaging is not possible. The panel suggests not using routine antibiotics when there is no evidence of pneumonia.

In outpatient adults with acute cough and suspected influenza, the panel suggests antiviral treatments within 48 hours; antiviral treatments may be linked to lower use of antibiotics, fewer hospitalizations, and optimal outcomes.

Apart from the guidelines, the panel suggested that “randomized controlled trials are needed to assess non-antibiotic symptomatic therapies for acute cough due to pneumonia.”

Reference

Hill AT, Gold PM, Solh AE, Metlay JP, Ireland B, Irwin RS. Adult outpatients with acute cough due to suspected pneumonia or influenza: CHEST guideline and expert panel report [published online 2018]. CHEST. doi:10.1016/j.chest.2018.09.016

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