This randomized clinical trial evaluated the effectiveness of rapid syndromic polymerase chain reaction (PCR) testing for community-acquired pneumonia (CAP) in the emergency department (ED). The study aimed to determine whether the judicious use of a PCR-based panel could lead to faster and more accurate microbiological test result-based treatment. Conducted at Haukeland University Hospital in Norway, the trial included 374 adult patients with suspected CAP, randomized 1:1 to either the intervention arm (rapid PCR testing plus standard care) or the standard-of-care arm (standard microbiological diagnostics alone). The primary outcomes were the provision of pathogen-directed treatment based on microbiological test results and the time to provision of such treatment within 48 hours after randomization. Results showed that the intervention arm had a significantly higher proportion of patients receiving pathogen-directed treatment (35.3% vs 13.4%) and a median time to treatment of 34.5 hours (vs 43.8 hours in the standard-of-care arm). The intervention also reduced the median time to pathogen-directed treatment by 9.4 hours. These findings suggest that routine deployment of PCR testing for lower respiratory tract pathogens can enable faster and more targeted microbial treatment for patients with suspected CAP, potentially improving clinical outcomes and reducing antibiotic overuse.This randomized clinical trial evaluated the effectiveness of rapid syndromic polymerase chain reaction (PCR) testing for community-acquired pneumonia (CAP) in the emergency department (ED). The study aimed to determine whether the judicious use of a PCR-based panel could lead to faster and more accurate microbiological test result-based treatment. Conducted at Haukeland University Hospital in Norway, the trial included 374 adult patients with suspected CAP, randomized 1:1 to either the intervention arm (rapid PCR testing plus standard care) or the standard-of-care arm (standard microbiological diagnostics alone). The primary outcomes were the provision of pathogen-directed treatment based on microbiological test results and the time to provision of such treatment within 48 hours after randomization. Results showed that the intervention arm had a significantly higher proportion of patients receiving pathogen-directed treatment (35.3% vs 13.4%) and a median time to treatment of 34.5 hours (vs 43.8 hours in the standard-of-care arm). The intervention also reduced the median time to pathogen-directed treatment by 9.4 hours. These findings suggest that routine deployment of PCR testing for lower respiratory tract pathogens can enable faster and more targeted microbial treatment for patients with suspected CAP, potentially improving clinical outcomes and reducing antibiotic overuse.