KAISER PERMANENTE

The Permanente Medical Group (TPMG) Clinical Practice Guidelines have been
developed to assist clinicians by providing an analytical framework for the evaluation and treatment
of selected common problems encountered in patients. These guidelines are not intended to establish a protocol for
all patients with a particular condition. While the guidelines provide one approach to evaluating a problem,
clinical conditions may vary significantly from individual to individual. Therefore, the clinician must exercise
independent judgment and make decisions based upon the situation presented.

While great care has been taken to assure the accuracy of the information presented, the reader is advised that
TPMG cannot be responsible for continued currency of the information, for any errors or omissions
in this guideline, or for any consequences arising from its use.

COMMUNITY ACQUIRED PNEUMONIA CLINICAL
PRACTICE GUIDELINES TEAM http://www.kaiserpapers.info/cajud/pnue/
CLINICAL LEADER
Mark Clark, MD,HBS,Vallejo
CPG TEAM
David Goya, MD, Pulmonology, Santa Clara
Chinh Le, MD, Infectious Disease, Santa Rosa
Nada Ferns, NP, Medicine, Hayward
PROJECT MANAGEMENT
Jay Krishnaswamy, MBA, TPMG Department of Quality and Utilization
Linda Rogers, MPA, TPMG Department of Quality and Utilization
EDITING
The Medical Editing Department,
Kaiser Foundation Research Institute
REVIEWERS
Norman Absar, MD, HBS, Vallejo
Henry Brodkin, MD, Medicine, Redwood City
Melanio Castro, MD, HBS, Stockton
Doug Chartier, MD, HBS, Oakland
Deborah Chiarucci, MD, HBS, Redwood City
Diane Craig, MD, HBS, Santa Clara
Mike Driscoll, DO, HBS, Sacramento
Louis Edelson, MD, HBS, Hayward
Paul Feigenbaum, MD, Medicine, San Francisco
Jerry Fessler, MD, HBS, Stockton
John Fitzgibbon, MD, HBS, Sacramento
Lauren Freeman, MD, HBS, South Sacramento
William Geisser, MD, HBS, Fresno
Dale Grahn, MD, HBS, Park Shadelands
Brian Hoberman, MD, HBS, San Francisco
Jianfei Hu, MD, HBS, Walnut Creek
Aye Koko, MD, HBS, Fresno
Pansy Kwong, MD, Medicine, Oakland
Lewis Lehman, MD, HBS, San Francisco
Janice Manjuck, MD, HBS, San Francisco
Greg Matsubara, MD, HBS, Fresno
Susanne Mierendorf, MD, HBS, Santa Clara
Joseph Murphy, MD, Medicine, South San Francisco
Bein Nguyen, MD, HBS, Santa Teresa
Keith Palmer, MD, HBS, San Francisco
Rita Patel, MD, HBS, Hayward
Andrew Pollock, MD, HBS, Sacramento
Robert Reisenfeld, MD, HBS, Walnut Creek
Thomas Tang, MD, HBS, Redwood City
Tien Trinh, MD, HBS, Santa Teresa
Than Tran, MD, HBS, Stockton
Abdul Wali, MD, HBS, Walnut Creek
Albert Wilbum, MD, HBS, Fresno
Thein Win, MD, HBS, Walnut Creek
Joseph Wong, MD, HBS, Stockton
Terry Woodard, MD, HBS, Santa Rosa
DESIGN & PRODUCTION

Gail Holan. Curvey

To obtain more information about KPNC Clinical
Practice Guidelines, printed copies, or permission to
reproduce any portion, please contact TPMG
Department of Quality & Utilization at 510-987-2950
or tie-line 8-427-2950, or send an e-mail message to
clinical.guidelines@ncal.kaiperm.org. Within the
KPNC Lotus Notes network mail to clinical guidelines or kpnc-cpg.
KPNC Clinical Practice Guidelines can be viewed on-
line on the Kaiser Permanente Northern California
intranet website at http://clinical-library.ca.kp.org.

Ratified by the Operations Management Group and the Quality Oversight Committee
Copyright 1998 The Permanente Medical Group, Inc.

   CLINICAL PRACTICE GUIDELINES FOR COMMUNITY ACQUIRED PNEUMONIA

Hospital based physicians and clinician-managers can be guided by admission criteria, evaluaton
and treatment recommendations, discharge criteria, expected measurable quality outcomes (such
as cure rate or mortality rate), and utilization outcomes (such as length of stay) ¹ Understanding
of these issues as they pertain to community acquired pneumonia (CAP) has progressed, in recent
years, to the point that certain evidence-based recommendations and predictions can be confidently
made.

We can now predict, based upon the initial history, physical findings, and laboratory evaluation,
which patients are likely to benefit from hospitalization for community acquired pneumonia.² This
has led to a set of well validated admission criteria for CAP, and allows us to forecast expected
mortality and length of stay based on the risk of mortality estimated at the time of admission.
Such a risk-adjusted approach takes into account the presence of other comorbid conditions, which
may also be active ^{3, 4, 5} Thus, these recommendations and predictions are applicable to the
complicated patients with CAP in our hospitals today. Certain interventions, such as early IV antibiotic 
administration and obtaining of blood cultures have been shown to have a beneficial effect on outcomes⁶Recommendations based on such evidence, and on strong consensus among treating 
physicians form the basis of this guideline. Where scientific evidence or strong consensus does not exist, 
no recommendations have been made. Where evidence does exist (e.g., in the admission decision or "door to needle time") such
recommendations are given special prominence and may become the focus of quality monitoring.⁷