Issues in Community-Acquired Pneumonia

Pneumonia is one of the most commonly diagnosed infectious diseases and is the third most frequent cause of death worldwide. Accurate statistics of community-acquired pneumonia incidence globally or in countries of various regions are lacking. Although the clinical diagnosis of pneumonia is not difficult, the etiology diagnosis to guide targeted specific antimicrobial therapy still poses a challenge even with novel molecular methods. This has led to different approaches and guidelines for the empiric treatment of community-acquired pneumonia, often with broad-spectrum antimicrobial agents which may play a role in fostering the worldwide development of antibiotic resistant bacteria. Severe community-acquired pneumonia, seen mainly at the extremes of age and in persons with chronic underlying diseases, is associated with high mortality of 20–40%. Pneumonia severity tools, such as CURB-65, have been developed over the past decade to assist emergency department physicians to recognize, admit, and implement rapid antimicrobial therapy in severely ill patients. The evidence for the beneficial effects of these tools will be reviewed in this chapter. Issues in the management of severe community-acquired pneumonia that are discussed include: combination with newer macrolides [irrespective of microbial etiology], value of adjunctive therapy such as corticosteroids and statins.