Research into community acquired pneumonia over the past two decades has focused on developing tools to measure the severity of illness and which antibiotics to choose. Several tools can now help clinicians identify patients with severe community acquired pneumonia in clinical settings.1 In people with severe disease, international guidelines recommend early treatment with broad spectrum antibiotics, which provide cover for atypical pathogens.2

It is less clear how best to manage patients during their stay in hospital. In this week's BMJ, a randomised trial by Oosterheert and colleagues reports the effect of switching from intravenous to oral antibiotics after three days rather than seven days in people with severe community acquired pneumonia.3 Until now, the lack of quality trial data in areas such as route of antibiotic administration, duration of treatment, and assessment of clinical stability has led to a conservative approach to …