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Conundrums in community-acquired pneumonia

Patrick G P Charles, Paul D R Johnson and M Lindsay Grayson
Med J Aust 2006; 185 (3): . || doi: 10.5694/j.1326-5377.2006.tb00496.x
Published online: 7 August 2006

Clinically useful CAP management guidelines are still elusive

Community-acquired pneumonia (CAP) continues to generate controversy. Although CAP is common and generally mild, it can be life-threatening. For the treating clinician there are many questions. How much effort should be directed to establishing the aetiology, given that the responsible pathogen is infrequently diagnosed? Should the patient be managed in hospital or at home? Should one choose older, established antibiotics that work most of the time or broad-spectrum therapy that treats all imaginable pathogens but is probably unnecessary, has a less established safety record and is likely to contribute to increased cost of treatment and the emergence of resistance?


  • 1 Department of Infectious Diseases, Austin Health, Melbourne, VIC.
  • 2 Department of Medicine, University of Melbourne, Melbourne, VIC.
  • 3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.



  • 1. Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001; 163: 1730-1754.
  • 2. Mandell LA, Marrie TJ, Grossman RF, et al. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. The Canadian Community-Acquired Pneumonia Working Group. Clin Infect Dis 2000; 31: 383-421.
  • 3. Mandell LA, Bartlett JG, Dowell SF, et al. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 2003; 37: 1405-1433.
  • 4. British Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults. Thorax 2001; 56 Suppl 4: iv1-iv64.
  • 5. Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005; 26: 1138-1180.
  • 6. Therapeutic Guidelines Limited. Therapeutic guidelines: antibiotic. 12th ed. Melbourne: TGL, 2003.
  • 7. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336: 243-250.
  • 8. Theerthakarai R, El-Halees W, Ismail M, et al. Nonvalue of the initial microbiological studies in the management of nonsevere community-acquired pneumonia. Chest 2001; 119: 181-184.
  • 9. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377-382.
  • 10. Charles PGP, Whitby M, Fuller A, et al. Etiology of community-acquired pneumonia (CAP) and usefulness of pneumonia severity assessments for predicting need for ICU admission in Australia [abstract]. 45th Interscience Conference on Antimicrobial Agents and Chemotherapeutics; 2005 Dec 16-19; Washington, DC, USA.
  • 11. Maxwell DJ, McIntosh KA, Pulver LK, Easton KL. Empiric management of community-acquired pneumonia in Australian emergency departments. Med J Aust 2005; 183: 520-524. <MJA full text>
  • 12. Aujesky D, Auble TE, Yealy DM, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005; 118: 384-392.
  • 13. Capelastegui A, Espana PP, Quintana JM, et al. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J 2006; 27: 151-157.
  • 14. Angus DC, Marrie TJ, Obrosky DS, et al. Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society diagnostic criteria. Am J Respir Crit Care Med 2002; 166: 717-723.
  • 15. Buising KL, Thursky KA, Black JF, et al. A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax 2006; 61: 419-424.
  • 16. Davidson R, Cavalcanti R, Brunton JL, et al. Resistance to levofloxacin and failure of treatment of pneumococcal pneumonia. N Engl J Med 2002; 346: 747-750.

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