Community-acquired pneumonia (CAP) remains a significant global health concern, recognized as a leading cause of mortality. Several factors elevate an individual’s susceptibility to CAP, notably advanced age and the presence of underlying medical conditions. Clinicians should suspect pneumonia in patients presenting with symptoms such as cough, dyspnea, pleuritic chest pain, or unexplained acute decline in functional or cognitive status. These symptoms are often accompanied by abnormal vital signs, including fever and tachycardia, along with pertinent findings upon lung auscultation.
Confirmation of pneumonia diagnosis necessitates objective evidence through chest radiography or ultrasonography. These imaging modalities help visualize lung infiltrates, a hallmark of pneumonia. To effectively guide treatment strategies and determine the appropriate care setting, validated pneumonia severity prediction scores are invaluable. These scores aid in differentiating between patients suitable for outpatient management and those requiring inpatient hospitalization. Furthermore, the utilization of procalcitonin as a biomarker can offer additional assistance in risk stratification, particularly in identifying severe infections.
For the majority of outpatients diagnosed with CAP, routine microbiologic testing of sputum or blood is not mandatory. Empirical antibiotic therapy is generally sufficient, with recommended options including a macrolide, doxycycline, or a respiratory fluoroquinolone. Patients requiring hospital admission necessitate a broader antibiotic approach, typically involving either a fluoroquinolone or a combination regimen of a beta-lactam plus a macrolide. In cases of severe CAP necessitating intensive care unit (ICU) admission, dual antibiotic therapy is crucial. This often entails a third-generation cephalosporin in conjunction with a macrolide, either alone or combined with a fluoroquinolone.
Specific considerations apply to patients with risk factors for Pseudomonas species. Their treatment should incorporate an anti-pseudomonal antibiotic and an aminoglycoside, alongside azithromycin or a fluoroquinolone. Similarly, individuals with risk factors for methicillin-resistant Staphylococcus aureus (MRSA) require targeted therapy with vancomycin, linezolid, or ceftaroline in resistant scenarios. Adjunctive corticosteroid administration within 36 hours of hospital admission for severe CAP has demonstrated benefits in reducing the risk of adult respiratory distress syndrome and shortening the duration of treatment.
Preventive measures are paramount in mitigating the burden of pneumococcal pneumonia. Both the 23-valent pneumococcal polysaccharide vaccine and the 13-valent pneumococcal conjugate vaccine are recommended for adults aged 65 years and older. These vaccinations are effective in decreasing the risk of invasive pneumococcal disease, including pneumonia.
