Decisions about Treating Community-Acquired Pneumonia

Whether to treat a patient with community-acquired pneumonia (CAP) as an outpatient or as an inpatient is an extremely important decision, yet admission rates vary considerably (1-3). The nature of investigational tests, the types and route of administration of drugs selected for treatment, and the cost of care all differ according to the site of care. Inpatient treatment costs are often 20 to 25 times greater than outpatient costs (4, 5).

An estimated 4 million cases of CAP occur annually in the United States. These cases account for at least 600 000 hospital admissions and 64 million days of restricted activity (6, 7). Eighty percent of patients with CAP are managed as outpatients. The remaining 20% account for the lion's share of the $8.5 billion to $10 billion spent annually on the treatment of CAP.

Outpatient management has certain advantages. Patients treated in the home are able to resume normal activities sooner. Because they are more active, they are less likely to experience thromboembolic events. They are also less likely to become infected with the more virulent and resistant pathogens found in the hospital, and they avoid intravascular catheter–related infections since they are usually treated with an oral antimicrobial agent (8). Patients who have less severe infections, and are therefore at lower risk for death, prefer outpatient to inpatient treatment by a ratio of 4 to 1 (9) …