Community-acquired pneumonia - An EFIM guideline critical appraisal adaptation for internists

Ahmet Gorkem Er, Alberto Antonio Romero Alonso, Ignacio Marin-Leon, Abdullah Sayiner, Stefano Bassetti, Kutay Demirkan, Patrick Lacor, Hartmut Lode, Wiktoria Lesniak, Mine Durusu Tanriover, Ali Fuat Kalyoncu, Nicolas Merchante Gutierrez, Serhat Unal

Research output: Contribution to journalArticlepeer-review


BACKGROUND: In real-life settings, guidelines frequently cannot be followed since many patients are multimorbid and/or elderly or have other complicating conditions which carry an increased risk of drug-drug interactions. This document aimed to adapt recommendations from existing clinical practice guidelines (CPGs) to assist physicians' decision-making processes concerning specific and complex scenarios related to acute CAP.

METHODS: The process for the adaptation procedure started with the identification of unsolved clinical questions (PICOs) in patients with CAP and continued with critically appraising the updated existing CPGs and choosing the recommendations, which are most applicable to these specific scenarios.

RESULTS: Seventeen CPGs were appraised to address five PICOs. Twenty-seven recommendations were endorsed based on 7 high, 9 moderate, 10 low, and 1 very low-quality evidence. The most valid recommendations applicable to the clinical practice were the following ones: Respiratory virus testing is strongly recommended during periods of increased respiratory virus activity. Assessing the severity with a validated prediction rule to discriminate where to treat the patient is strongly recommended along with reassessing the patient periodically for improvement as expected. In adults with multiple comorbidities, polypharmacy, or advanced age, it is strongly recommended to check for possible drug interactions before starting treatment. Strong graded recommendations exist on antibiotic treatment and its duration. Recommendations on the use of biomarkers such as C-reactive protein or procalcitonin to improve severity assessment are reported.

CONCLUSION: This document provides a simple and reliable updated guide for clinical decision-making in the management of complex patients with multimorbidity and CAP in the real-life setting.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalEuropean Journal of Internal Medicine
Early online date2022
Publication statusPublished - Dec 2022

Bibliographical note

Publisher Copyright:
© 2022

Copyright 2022 Elsevier B.V., All rights reserved.


  • Clinical guideline
  • Community-acquired-pneumonia
  • Drug interactions
  • Guideline adaptation
  • Multimorbidity
  • Treatment
  • internal medicine


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