Many recommendations remain based on the lowest grades of evidence

New guidelines from the British Thoracic Society for managing community acquired pneumonia in adults were published in December 2001 in Thorax.1 They have been formulated using modern methods with explicit search strategies and appraisal criteria. Recommendations are graded according to the strength of the supporting evidence. They cover the assessment and management of pneumonia in the community as well as in hospital. They do not cover the much larger group of non-pneumonic lower respiratory tract illnesses including exacerbations of chronic obstructive pulmonary disease, nor patients with predisposing illnesses such as cancer or AIDS. Many of the practical recommendations remain based on the lowest grades of evidence.

What important issues emerge from these voluminous guidelines for primary care? Streptococcus pneumoniae remains the most common bacterial pathogen, but there is a lack of recent comprehensive studies of aetiology from the United Kingdom. The one community based study from the United Kingdom cited here found S pneumoniae in 36% of patients and atypical pathogens in about only 1%.2 This study, however, dates from 1987 and more recent studies from the rest of …