Department of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, Scotland.
Loma Linda University School of Medicine, Loma Linda, CA.
Chest. 2019 Jan;155(1):155-167. doi: 10.1016/j.chest.2018.09.016. Epub 2018 Oct 6.
Patients commonly present to primary care services with upper and lower respiratory tract infections, and guidelines to help physicians investigate and treat acute cough due to suspected pneumonia and influenza are needed.
A systematic search was carried out with eight patient, intervention, comparison, outcome questions related to acute cough due to suspected pneumonia or influenza.
There was a lack of randomized controlled trials in the setting of outpatients presenting with acute cough due to suspected pneumonia or influenza who were not hospitalized. Both clinical suggestions and research recommendations were made on the evidence available and CHEST Expert Cough Panel advice.
For outpatient adults with acute cough due to suspected pneumonia, we suggest the following clinical symptoms and signs are suggestive of pneumonia: cough; dyspnea; pleural pain; sweating, fevers, or shivers; aches and pains; temperature ≥ 38°C; tachypnea; and new and localizing chest examination signs. Those suspected of having pneumonia should undergo chest radiography to improve diagnostic accuracy. Although the measurement of C-reactive protein levels strengthens both the diagnosis and exclusion of pneumonia, there was no added benefit of measuring procalcitonin levels in this setting. We suggest that there is no need for routine microbiological testing. We suggest the use of empiric antibiotics according to local and national guidelines when pneumonia is suspected in settings in which imaging cannot be performed. Where there is no clinical or radiographic evidence of pneumonia, we do not suggest the routine use of antibiotics. There is insufficient evidence to make recommendations for or against specific nonantibiotic, symptomatic therapies. Finally, for outpatient adults with acute cough and suspected influenza, we suggest that initiating antiviral treatment (according to Centers for Disease Control and Prevention advice) within 48 hours of symptoms could be associated with decreased antibiotic use and hospitalization and improved outcomes.
患者常因上呼吸道和下呼吸道感染到基层医疗服务机构就诊，因此需要有指南来帮助医生对疑似肺炎和流感引起的急性咳嗽进行调查和治疗。
针对疑似肺炎或流感引起的急性咳嗽，进行了一项系统检索，共提出了 8 个与患者、干预、比较、结局相关的问题。
在未住院的因疑似肺炎或流感而出现急性咳嗽的门诊患者中，缺乏随机对照试验。根据现有证据和 CHEST 专家咳嗽小组的建议，提出了临床建议和研究建议。
对于因疑似肺炎而出现急性咳嗽的门诊成年人，我们建议以下临床症状和体征提示肺炎：咳嗽；呼吸困难；胸痛；出汗、发热或寒战；疼痛；体温≥38°C；呼吸急促；新出现的且局部化的胸部检查体征。怀疑患有肺炎的患者应进行胸部 X 线检查以提高诊断准确性。虽然 C 反应蛋白水平的测量既可以增强肺炎的诊断，也可以排除肺炎，但在这种情况下测量降钙素原水平并无额外获益。我们建议无需常规进行微生物学检测。在无法进行影像学检查的情况下，疑似肺炎时应根据当地和国家指南使用经验性抗生素。在没有临床或影像学肺炎证据的情况下，我们不建议常规使用抗生素。没有足够的证据支持或反对常规使用非抗生素、对症治疗。最后，对于因疑似流感而出现急性咳嗽的门诊成年人，我们建议根据美国疾病控制与预防中心的建议，在症状出现后 48 小时内开始抗病毒治疗，可能与减少抗生素使用和住院以及改善结局有关。
