Management of community-acquired pneumonia

This article summarizes recent literature related to community-acquired pneumonia (CAP), which continues to represent one of the most common causes of morbidity and mortality throughout the world, especially in the elderly. The impact is even more striking if we take healthcare costs into account. Patients with CAP usually have other comorbidities which not only increase mortality in this group but also add further to its economic burden. Patients with COPD, pre-existing cardiac disease, and diabetes are particularly at higher risk for developing more severe pneumonia. New diagnostic modalities, including ultrasonography, are being used more commonly in clinical practice. Procalcitonin levels can be used to identify bacterial pneumonia and to de-escalate antibiotic therapy, resulting in fewer days on antibiotics. Other biomarkers have been used in studies to stratify patients by risk. Guideline-concordant regimens including atypical coverage, and macrolides in particular, appear to provide benefit. More recent data suggest the need for careful screening of patients for cardiovascular risk factors prior to initiating macrolides and fluoroquinolones.