Because of the development of effective oral antibiotics (respiratory fluoroquinolones, extended spectrum macrolides), many patients with community-acquired pneumonia (CAP) can be managed as an outpatient as long as compliance and close follow-up are assured. The CURB-65 score is a validated instrument for determining if inpatient admission (either observation or full admission) is indicated. Factors predicting increased severity of infection include confusion, urea above 19 mg/dL, respiratory rate above 30, BP below 90 systolic (or 60 diastolic), and age 65 or above. If more than one of these factors is present, hospitalization should be considered.This patient's presentation (lobar pneumonia, pleuritic pain, purulent sputum) suggests pneumococcal pneumonia. The pneumococcus is the commonest organism isolated from patients with CAP. Fortunately, Spneumoniae is almost always sensitive to oral antibiotics such as clarithromycin/azithromycin and the respiratory fluoroquinolones. A Gram stain suggestive of pneumococci would therefore only confirm the clinical diagnosis. Exposure to influenza is an important historical finding. Patients with influenza often have a prodrome (upper respiratory symptoms, myalgias, prostrating weakness), but influenza would not cause a lobar infiltrate. Staphylococcus aureus pneumonia can sometimes follow influenza. Acute lobar pneumonia, even in an HIV-positive patient, is usually due to the pneumococcus and can often be treated as an outpatient. Pneumocystis jiroveci pneumonia is usually insidious in onset, causes diffuse parenchymal infiltrates, and does not cause pleurisy or pleural effusion. Physical examination signs of consolidation confirm the CXR finding of a lobar pneumonia (as opposed to a patchy bronchopneumonia) and would simply affirm the importance of coverage for classic bacterial pathogens (i.e., pneumococci, H influenzae). Atypical pneumonias (due to Mycoplasma, Chlamydia, or Legionella) are usually patchy and do not usually cause pleural effusion. Currently recommended treatment regimens for CAP cover both typical and atypical pathogens.