Management of community-acquired pneumonia in adults

Am J Respir Crit Care Med. 2011 Jan 15;183(2):157-64. doi: 10.1164/rccm.201002-0272CI. Epub 2010 Aug 6.


Despite many advances in medical science, the mortality rate from community-acquired pneumonia (CAP) has changed little in the past four decades. Death and adverse outcomes from CAP result from a complex interplay between the pathogen and the host. Newer information about the effect of pneumonia on comorbidity and underlying diseases, especially long term, suggests this is an important additional axis that differs from the traditional triangular concept of pathogen, host defense, and antibiotic treatment. A number of clinical scoring systems have been developed to help physicians identify patients with CAP at risk of adverse outcomes. None of the criteria have been prospectively demonstrated to avoid late intensive care unit transfers or lower mortality, raising interest in the use of biomarkers such as procalcitonin. Quantitative bacterial genomic load represents a potentially important risk stratification. Optimal antibiotic management appears to include use of a macrolide, although the mechanism of benefit remains unclear. Attempts to improve CAP outcomes through setting measurable process of care standards are to be applauded, but making sure that these standards do not become the end in themselves, but rather that the entire process of care is improved, remains critical.

Publication types

  • Review

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Biomarkers / blood
  • Community-Acquired Infections / blood
  • Community-Acquired Infections / drug therapy*
  • Humans
  • Pneumonia / blood
  • Pneumonia / drug therapy*
  • United States


  • Anti-Bacterial Agents
  • Biomarkers