PREVENTION OF COMMUNITY-ACQUIRED PNEUMONIA

More than 4.5 million Americans develop community-acquired pneumonias (CAP) annually. Of these, about 1 million persons are hospitalized, generating more than $4 billion in medical expenses.(2, 16) Despite the availability of dozens of antibiotics and an ever-increasing array of interventions, CAP is an important cause of morbidity and ranks sixth in cause-specific mortality for Americans.(9) Over the last three decades, much has been learned about the epidemiology and pathogenesis of CAP, and from this body of knowledge, several preventive interventions have emerged. This article describes the preventive strategies of immunization, immunoprophylaxis, and chemoprophylaxis in accord with contemporary understanding of pulmonary host defenses and the pathogens that are the principal causative agents of CAP. Emphasis is on CAP in the setting of normal care provided by the primary care internist.