Community-Acquired Pneumonia vs Acute Bronchitis
Community-Acquired Pneumonia and Acute Bronchitis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Community-Acquired Pneumonia vs Acute Bronchitis at a glance
- Community-Acquired Pneumonia: Lower respiratory tract infection acquired outside of healthcare settings.
- Acute Bronchitis: Self-limited inflammation of the large airways, almost always viral.
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Side-by-side comparison
| Feature | Community-Acquired Pneumonia | Acute Bronchitis |
|---|---|---|
| At a glance | Lower respiratory tract infection acquired outside of healthcare settings. | Self-limited inflammation of the large airways, almost always viral. |
| Classic presentation | Lobar consolidation with bronchial breath sounds and egophony classically points to S. pneumoniae; bullous myringitis with patchy infiltrates suggests Mycoplasma.; Cough (productive purulent sputum, or dry), fever, chills, rigors; Pleuritic chest pain, dyspnea; Constitutional: fatigue, myalgia, anorexia; Elderly may present atypically:… | Cough — initially dry, often becoming productive of clear or purulent sputum (PURULENT SPUTUM ALONE DOES NOT INDICATE BACTERIAL INFECTION); Mild dyspnea, wheeze, chest discomfort with coughing; Often preceded by URI symptoms: rhinorrhea, sore throat, mild fever (low-grade); Cough typically resolves within 1-3 weeks; postinfectious cough… |
| Workup / key labs | CBC (leukocytosis with left shift), BMP, lactate, procalcitonin (helps de-escalate antibiotics); Blood cultures × 2 if severe, ICU admission, immunocompromise, or cavitary disease; Sputum Gram stain and culture if severe or specific pathogen suspected; Urine antigens: S. pneumoniae and Legionella (severe CAP, Legionella outbreak,… | Generally NONE needed in immunocompetent ambulatory patients with classic presentation; Procalcitonin and CRP not routinely indicated but can support antibiotic stewardship; Targeted viral testing: influenza (if antivirals considered or seasonal/outbreak), SARS-CoV-2 (per current public health guidance), RSV in select populations;… |
| Imaging | Chest radiograph (PA and lateral) — REQUIRED to diagnose pneumonia; lobar consolidation, interstitial infiltrate, or cavitation; CT chest if non-resolving, complicated (abscess, empyema), or unclear; Bedside lung ultrasound — increasingly used in EDs | Chest radiograph NOT routinely needed — obtain if any of: HR >100, RR >24, T >38°C, focal exam findings (consolidation, rales), age >65, or immunocompromise — to exclude pneumonia; CDC/IDSA suggest CXR to differentiate from CAP when clinical picture is uncertain |
| First-line treatment | Outpatient, no comorbidities, no recent antibiotics: amoxicillin 1 g TID OR doxycycline 100 mg BID OR macrolide (azithromycin, clarithromycin) if local pneumococcal resistance <25%; Outpatient with comorbidities (heart, lung, liver, renal, diabetes, alcohol, malignancy, asplenia): beta-lactam (amoxicillin-clavulanate 875 mg BID or… | Symptomatic and supportive care — antibiotics generally NOT indicated (high-value care); Hydration, rest; Antitussives (dextromethorphan, benzonatate) for bothersome cough (modest evidence); Honey 1-2 tsp (for adults and children ≥1 year) — evidence-based cough relief, particularly nocturnal; Throat lozenges, humidified air; Inhaled… |
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