Recent changes in the management of community acquired pneumonia in adults

doi:10.1136/bmj.a285

BMJ 2008;336:1429-1433 (21 June), doi:10.1136/bmj.a285

Clinical Review

Recent changes in the management of community acquired pneumonia in adults

Hannah J Durrington, Wellcome Trust clinical research training fellow and honorary specialist registrar in respiratory medicine , Charlotte Summers, Wellcome Trust clinical research training fellow and honorary specialist registrar in respiratory medicine

¹ Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge CB2 2QQ

Correspondence to: C Summers cs493@medschl.cam.ac.uk

The first 150 words of the full text of this article appear below.

In 1901 William Osler described pneumonia as the "captain ofthe men of death."¹ Mortality has altered little since penicillinbecame routinely available, and community acquired pneumoniaremains a leading cause of mortality worldwide.² Here, we reviewstudies published in the past two years and focus on changesin the aetiology, stratification of severity, and antimicrobialmanagement of community acquired pneumonia in adults.

Sources and selection criteria

We searched Medline with thephrase "((community acquired pneumonia [title]) not (infant*or neonat* or child*))" and restricted the search to articlespublished in English in the previous two years. We identified149 articles, the titles of which we reviewed to identify majorthemes. Where necessary we made additional searches based onthe themes highlighted by the initial search. We then used thisinformation to prepare a brief review of the sections with whichwe were most familiar.

What is community acquired pneumonia and how is it diagnosed?

The British Thoracic Society (BTS) defines community acquiredpneumonia . . . [Full text of this article]

How common is community acquired pneumonia?

What organisms cause community acquired pneumonia?

Box 1 Common causes of community acquired pneumonia treatedin different healthcare settings in order of incidence⁷
Outpatients
Inpatients
Intensivecare unit

How has the aetiology of community acquired pneumonia changed?

Pneumococcal vaccination
Unanswered questions
Community acquired MRSA

Which antibiotics should be used to treat community acquired pneumonia?

How quickly should we give antibiotics?

Additional educational resources
Information for healthcareprofessionals
Information resources forpatients
Tips for non-specialists

Length of antibiotic treatment

Severity scores

Box 2 CURB-65 severity score¹⁴
Method
Interpretationof CURB-65 score
Summary points

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