Studies with participants selected for low/moderate severity CAP or age <65 years (n=6 studies, n=1217 individual participants) |
Bruns [6] | The Netherlands | November 2000– July 2003 | Multicentre prospective cohort | 119 adults with CAP | Normalisation of CAP score at day 10: 32.0%; physician-rated clinical cure at day 28: 88.9% |
CAP aetiology: S. pneumoniae 27.7% |
Selection criteria: age: unselected (mean±sd age 56.6±17.8 years); severity: low severity, PSI <110 (mean±sd PSI 65.5±22.1); comorbid disease: unselected; immune status: unselected |
Carratala [16] | Spain | October 2000– October 2002 | Cohort from multicentre RCT | 224 adults with CAP: 101 patients in hospitalised cohort | SF-36 score: “At 30-day follow-up SF-36 scores remained abnormal, but had returned towards baseline for Spanish population” |
CAP aetiology: S. pneumoniae 14.0%, L. pneumophila 4.4%, H. influenzae 2.6%, “atypical” 2.6% |
Selection criteria: age: unselected (mean±sd age: outpatient group 67.5±11.8 years; inpatient group 64.9±13.4 years); severity: low severity, PSI classes II and III (mean±sd PSI: outpatient group 70±11.6; inpatient group 66.9±12.5); comorbid disease: excluded if pregnant, breastfeeding, respiratory failure, concomitant unstable comorbid conditions necessitating hospitalisation, complicated pleural effusion, lung abscess, shock, metastatic infection, severe social problems, cognitive impairment, psychiatric disease; immune status: immunocompetent only (excluded HIV, splenectomy, immunosuppressive therapy, corticosteroid therapy, neutropenia, solid organ transplant); other: excluded if quinolone allergy or quinolone therapy in preceding 3 months |
Daniel [17] | UK | February 2015– April 2016 | Multicentre prospective cohort | 108 adults with CAP (male 48.2%) | Proportion of patients reporting prevalence of symptoms and functional impairment at 28 days following discharge: cough 31.9%, dyspnoea 27.5%, chest pain 16.5%, sputum 11.0%, fatigue 12.1%, ≥1 symptom 58.2%, not returned to ADLs 51.1%, not returned to work 34.3%; reconsultation within 28 days: ED attendance 12.0%, primary care 59.2% |
CAP aetiology: S. pneumoniae 16.7% |
Selection criteria: age: 18–65 years only (median (IQR) age 50 (38.3–57.8) years); severity: unselected (CURB-65 0–1: 88.9%; CURB-65 2: 9.3%; CURB-65 ≥3: 1.8%); comorbid disease: unselected; immune status: unselected |
El Moussaoui [18] | The Netherlands | November 2000– July 2003 | Cohort from multicentre RCT | 91 adults with CAP (male 58.8%) | Median (IQR) CAP scores: day 3, 56 (38–69); day 7, 60 (37–75); day 10, 65 (37–86); day 14, 77 (61–88); day 28, 75 (58–93) |
CAP aetiology: S. pneumoniae 23.8% |
Selection criteria: age: unselected (median (IQR) age 65 (48–72) years); severity: low severity, PSI <110 (mean±sd PSI 71±23); comorbid disease: excluded if pregnant, severe underlying disease, preceding antibiotic treatment for >24 h prior to admission, concurrent comorbid disease likely to interfere with course of pneumonia, respiratory failure; immune status: unselected; other: excluded if amoxicillin allergy |
Laberere [20] | USA/ Canada | January 2001– December 2001 | Cohort from multicentre RCT | 549 adults with CAP (male 44%) | Median (IQR) time for return to ADLs: workers 22 (11–29) days, nonworkers 20 (9–29) days; median (IQR) time return to work 14 (8–29) days |
CAP aetiology: not reported |
Selection criteria: age: unselected (median (IQR) age 66 (48–77) years); severity: low severity, PSI classes I–III (PSI I: 16.0%; PSI II: 41.0%; PSI III: 43.0%); comorbid disease: excluded if pulmonary tuberculosis, alcoholism and evidence of end-organ damage, social problems incompatible with recruitment, illicit drug use 30 days; immune status: immunocompetent only (excluded if HIV, immunosuppression) |
Metlay [22] | USA | April 1996– February 1997 | Single-centre prospective cohort | 126 adults with CAP (male 54.8%) | Proportion of patients reporting prevalence of symptoms at 28 days following discharge: cough 19.9%, dyspnoea 16.8%, fatigue 25.7%, fever 3.5%, ≥1 symptom 35.0% |
CAP aetiology: not reported |
Selection criteria: age: 18–64 years; severity: low severity, PSI classes I–III (mean PSI 55.2); comorbid disease: excluded if pregnancy, severe neuromuscular disease; immune status: immunocompetent only (excluded if chronic immunosuppression, HIV); other: nursing home residence, psychological or social problems compromising follow-up |
Studies where participants were unselected for severity or age (n=9 studies, n=4427 individual participants) |
Adamuz [14] | Spain | January 2007– December 2009 | Single-centre prospective cohort | 828 adults with CAP (male 65.8%) | Healthcare utilisation at 30 days: ED 21.4%, primary care 18.0%; symptoms reported in participants reconsulting within 30 days: primary care (n=149): respiratory symptoms 75.2%, general symptoms 22.8%; ED (n=177): worsening pneumonia symptoms 47.5% |
CAP aetiology: S. pneumoniae 44.1%, L. pneumophila 3.0%, H. influenzae 4.4%, anaerobes 5.6% |
Selection criteria: age: unselected (median (IQR) age 71 (55–79) years); severity: unselected (PSI >90 in 62.2%); comorbid disease: unselected; immune status: immunocompetent only (excluded HIV, splenectomy, immunosuppressive therapy, corticosteroid therapy equivalent to prednisolone >20 mg daily, neutropenia, Ig deficiency, solid organ transplant); other: excluded if inpatient death |
Adamuz [15] | Spain | January 2011– October 2014 | Multicentre RCT | 207 adults with CAP (male 59.9%) | Healthcare utilisation at 30 days: primary care 20.3%, ED 18.4%; median (IQR) time off work: intervention group 30 (15–66.5) days, usual care group 26 (12.5–37) days |
CAP aetiology: S. pneumoniae 24.6%, H. influenzae 5.4%, influenzae A 3.4% |
Selection criteria: age: unselected (21–49 years: 20.2%; 50–69 years: 30.5%; >70 years: 49.3%); severity: unselected (CURB-65 0–1: 49.3%; CURB-65 2: 34.3%; CURB-65 ≥3: 16.4%); comorbid disease: excluded cognitive impairment; immune status: immunocompetent only (excluded HIV, splenectomy, immunosuppressive therapy, corticosteroid therapy equivalent to prednisolone >20 mg daily, neutropenia, Ig deficiency, solid organ transplant); other: excluded if nursing home resident or long-term care facility, language barrier |
Fine [19] | USA/ Canada | October 1991– March 1994 | Multicentre prospective cohort | 1343 adults with CAP (male 52.4%) | Proportion of patients reporting prevalence of symptoms and functional impairment at 30 days following discharge: cough 47.1%, dyspnoea 46.5%, sputum 42.3%, fatigue 72.6%, ≥1 symptom 68.5%; not returned to ADLs: workers 18% (median 15 days), nonworkers 42.8% (median 24 days); not returned to work 31.9% |
CAP aetiology: S. pneumoniae 9.1%, H. influenzae 4.8%, “atypical” 2.1%, Enterobacter sp. 2.8%, P. aeruginosa 0.9% |
Selection criteria: age >65 years 58.7%; severity: unselected (PSI I: 13.8%; PSI II: 17.4%; PSI III: 18.9%; PSI IV: 33.2%; PSI V: 16.7%); comorbid disease: unselected; immune status: excluded if HIV |
Marrie [21] | Canada | January 1998– July 1998 | Multicentre prospective cohort | 535 adults with CAP (male 52.3%) | Proportion of patients reporting prevalence of symptoms/functional impairment at 14/42 days following discharge: cough 55.8%/35.3%, dyspnoea 48.6%/34.2%, chest pain 17.3%/11.6%, sputum 35.9%/26.4%, fatigue 66.7%/45.0%, fever 8.4%/4.7%, ≥1 symptom 85.6%/64.3% |
CAP aetiology: not reported |
Selection criteria: age: unselected (mean±sd age 61.6±19.1 years); severity: unselected (mean±sd PSI 76.2±32.8); comorbid disease: unselected; immune status: unselected |
Nickler [23] | Switzerland | October 2006– March 2008 | Cohort from multicentre RCT | 753 adults with CAP (male 58.8%) | EQ-5D index: decline in ADLs in 29% at day 30 |
CAP aetiology: not reported |
Selection criteria: age: unselected (median (IQR) age 72 (52–82) years); severity: unselected (PSI I: 10.0%; PSI II: 19.7%); comorbid disease: excluded if terminal illness; immune status: immunocompetent only (excluded if long-term immunosuppression); other: excluded if language impairment precluding written consent, i.v. drug abuse |
Sharma [24] | USA | March 1995– March 1998 | Single-centre prospective cohort | 79 adults with CAP (male 35%) | Proportion with decline in ADLs score of >1 point 28% at day 30 |
CAP aetiology: not reported |
Selection criteria: age: unselected (mean±sd age 79.9±6.1 years); severity: unselected (mean±sd PSI 106.2±23.9); comorbid disease: excluded if terminal illness; immune status: unselected; other: excluded if coma, intensive care admission, unable to participate in interview |
Uranga [25] | Spain | January 2012– August 2013 | Multicentre RCT | 312 adults with CAP (male 62.8%) | Mean±sd CAP-symptom score at 5 days 24.7±11.4 to 27.2±12.5; mean±sd CAP-symptom score at 10 days 18.6±9.0 to 17.9±7.6; median (IQR) time for return to normal activity 15 (10–21) to 18 (9–25) days |
CAP aetiology: S. pneumoniae 16.0%, L. pneumophila 3.5%, H. influenzae 0.3% |
Selection criteria: age: unselected (mean±sd age 62.2±6.07 and 64.7±18.7 years in the control and intervention groups, respectively); severity: unselected (mean±sd PSI 83.7±33.7 and 81.8±33.8, in the control and intervention groups, respectively); comorbid disease: unselected; immune status: immunocompetent only (excluded if HIV, immunosuppression for solid organ transplantation, splenectomy, receiving ≥10 mg·day−1 prednisone equivalent for >30 days, taking other immunosuppressive agents, neutropenia); other: excluded if care home resident, antibiotics within preceding 30 days, intercostal chest drain, extrapulmonary manifestations, death or ICU admission prior to randomisation |
Wootton [26] | UK | February 2011– March 2013 | Multicentre prospective cohort | 169 adults with CAP (male 52%) | Average CAP-symptom score 23.8 at day 2; average CAP-symptom score 13.6 at day 28; proportion of patients reporting prevalence of symptoms at 28 days following discharge: cough 13.6%, dyspnoea 67.1%, chest pain 31.2%, fatigue 57.0%, ≥1 symptom 96.4% |
CAP aetiology: not reported |
Selection criteria: age: unselected (mean±sd age 68 (range 16–98) years); severity: unselected (CURB-65 0–1: 46.7%; CURB-65 2: 29.6%; CURB-65 ≥3: 23.7%); comorbid disease: excluded if bronchiectasis, cystic fibrosis, advanced malignancy; immune status: unselected; other: excluded if palliative treatment, invasive ventilation |
Wyrwich [27] | USA | Unknown | Multicentre retrospective cohort | 201 adults with CAP (male 45%) | Mean (median (IQR)) time to symptom resolution: cough 13.6 (7 (2–14)) days, dyspnoea 25.1 (14 (7–43)) days, chest pain 12.9 (7 (2–14)) days, sputum 14.8 (7 (7–14)) days, fatigue 25 (20 (7–24)) days, fever 2.7 (2 (1–2)) days; median time for return to work 14 days |
CAP aetiology: not reported |
Selection criteria: age: ≥50 years; severity: unselected; comorbid disease: unselected; immune status: unselected; other: respondent to e-mail survey, excluded if nursing home resident |