to the editor: In the article, “Diagnosis and Treatment of Community-Acquired Pneumonia,”¹ the discussion of outpatient versus inpatient treatment did not list the absolute contraindications to outpatient treatment. These contraindications include: hypoxemia (oxygen saturation less than 90 percent while patient is breathing room air), hemodynamic instability, active coexisting condition requiring hospitalization, and inability to tolerate oral medications.² When applying a clinical decision rule to an individual patient, it is imperative to recognize exclusion criteria to avoid misapplication of the rule.

editor’s note: This letter was sent to the authors of “Diagnosis and Treatment of Community-Acquired Pneumonia,” who declined to reply.