When should a patient with community-acquired pneumonia (CAP) follow up with their healthcare provider after initiating antibiotic therapy?

Follow-Up Timing for Outpatient Community-Acquired Pneumonia

All patients treated for outpatient CAP should have a clinical review at approximately 6 weeks after initiating antibiotic therapy, with a follow-up chest radiograph arranged at that time for smokers and patients over 50 years old to exclude underlying malignancy. 1

Early Assessment (48-72 Hours)

• Patients should be instructed to return if fever does not resolve within 48 hours of starting antibiotics 1
• If clinical findings are not improving or are deteriorating after initial empiric therapy by Day 3, a careful re-evaluation is necessary to identify treatable causes 1
• Most patients with CAP will have an adequate clinical response within 3 days when receiving appropriate antibiotic therapy 1

Six-Week Follow-Up Visit (Primary Recommendation)

Clinical review should be arranged for all patients at around 6 weeks, either with their general practitioner or in a hospital clinic 1

Chest Radiograph Indications at 6 Weeks

A follow-up chest radiograph should be obtained for:

• All smokers and patients over 50 years old to establish a new radiographic baseline and exclude the possibility of malignancy associated with CAP 1
• Patients with persistent symptoms or physical signs at 6 weeks 2, 3
• Patients with recurrent pneumonia in the same lobe or initial lobar collapse 2

Patients Who May Not Need Follow-Up Imaging

• Younger patients (under 50 years) who are non-smokers and have made a satisfactory clinical recovery without persistent symptoms do not routinely require follow-up chest radiography 2, 3
• In clinically improving patients without concerning features, radiological improvement typically lags behind clinical recovery, and this is not clinically significant 1

Additional Considerations for Follow-Up Planning

• It is the responsibility of the hospital team or treating provider to arrange the follow-up plan with the patient and communicate this to the general practitioner 1
• Patients should be offered access to information about CAP, such as a patient information leaflet, at discharge or follow-up 1
• Further investigations, including bronchoscopy, should be considered in patients with persisting signs, symptoms, and radiological abnormalities about 6 weeks after completing treatment 1, 2

Common Pitfalls to Avoid

• Do not repeat chest radiographs prior to hospital discharge or early in treatment in patients who are clinically improving, as early radiographic changes do not correlate with clinical response 1
• Do not dismiss the need for follow-up in high-risk patients (smokers, age >50) even if they appear clinically well, as underlying malignancy must be excluded 1
• Do not assume radiographic clearing occurs at the same pace as clinical improvement—radiographic abnormalities may persist for weeks despite complete clinical resolution 1