Can lung ultrasound guide the decision of antibiotic treatment in patients with community acquired pneumonia?

Aims: The aim of this study was to investigate whether lung ultrasound (LUS) enables clinicians to differentiate between viral and bacterial community-acquired pneumonia (CAP) in the adult population, and to assess whether the use of LUS can support the decision-making process regarding antibiotic therapy. Methods: This review was conducted using data retrieved from PubMed and Google Scholar. The search was limited to studies published in English between 2015 and 2025, focusing on the adult population. Results: LUS demonstrates high predictive value in distinguishing viral from bacterial CAP, reduces diagnostic uncertainty, and supports appropriate initiation or withholding of antibiotic therapy in hospital care. Typical findings for different CAP etiologies have been identified. In both adult and elderly populations, LUS is more sensitive and specific than chest X-ray. In primary care, the combination of LUS and procalcitonin did not significantly reduce antibiotic use. Conclusions: LUS can effectively assist in the diagnosis of CAP and reduce unnecessary antibiotic prescriptions in hospital care. Typical ultrasound findings, such as the presence of large consolidations, may assist in identifying CAP etiology. However, specific cut-off values for consolidation size that would allow classification of CAP etiology as bacterial have yet to be established. LUS should be preferred over chest X-ray in adults, specifically in geriatric patients. Furthermore, there is a lack of sufficient studies evaluating the use of LUS as a sole diagnostic tool in the primary care setting.