Perspectives from Sri Lankan physicians on current approaches to diagnosing and managing lower respiratory tract infections

Lower respiratory tract infections (LRTIs) pose significant diagnostic challenges, especially in low- and middle-income countries (LMICs), where access to diagnostics and clinical tools is limited. This qualitative study explored Sri Lankan physicians’ attitudes and practices regarding current approaches to diagnosing and managing LRTIs in adult patients. We interviewed fifteen internal medicine physicians from six public hospitals throughout Sri Lanka. Participants’ management of LRTIs primarily depended on clinical history, basic investigations such as white blood cell count, and clinical judgment and experience. Guidelines (e.g., from the Sri Lankan College of Microbiologists and British Thoracic Society) were consulted, but physicians reported deviations when faced with drug unavailability or severe LRTI cases. Use of rapid pathogen-based diagnostics was limited given resource constraints. The biomarker test C-reactive protein (CRP) was used commonly, while the biomarker test procalcitonin (PCT) was used rarely due to high cost and limited access. Physicians frequently used clinical decision support tools (CDSTs), including CURB-65 and the Pneumonia Severity Index (PSI), on their mobile phones for determining severity of LRTI. Overall, physicians relied on a combination of clinical judgment and CDSTs, with selective use of guidelines and rapid diagnostics, in managing LRTIs. These results can help inform the development of strategies for improving the diagnosis and management of LRTIs in Sri Lanka.