Clinical Review

Recent changes in the management of community acquired pneumonia in adults

BMJ 2008; 336 doi: (Published 19 June 2008) Cite this as: BMJ 2008;336:1429
  1. Hannah J Durrington, Wellcome Trust clinical research training fellow and honorary specialist registrar in respiratory medicine ,
  2. Charlotte Summers, Wellcome Trust clinical research training fellow and honorary specialist registrar in respiratory medicine
  1. 1Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge CB2 2QQ
  1. Correspondence to: C Summers cs493{at}
  • Accepted 27 May 2008

In 1901 William Osler described pneumonia as the “captain of the men of death.”1 Mortality has altered little since penicillin became routinely available, and community acquired pneumonia remains a leading cause of mortality worldwide.2 Here, we review studies published in the past two years and focus on changes in the aetiology, stratification of severity, and antimicrobial management of community acquired pneumonia in adults.

Sources and selection criteria

We searched Medline with the phrase “((community acquired pneumonia [title]) not (infant* or neonat* or child*))” and restricted the search to articles published in English in the previous two years. We identified 149 articles, the titles of which we reviewed to identify major themes. Where necessary we made additional searches based on the themes highlighted by the initial search. We then used this information to prepare a brief review of the sections with which we were most familiar.

What is community acquired pneumonia and how is it diagnosed?

The British Thoracic Society (BTS) defines community acquired pneumonia as the presence of symptoms and signs consistent with acute lower respiratory tract infection, in association with new radiographic shadowing (figure) for which there is no alternative explanation, which is managed as pneumonia and is the main reason for seeking healthcare advice.3 This definition may not be useful, however, when radiology is not easily accessible. A review of studies that used clinical definitions based on symptoms and signs found these alternative definitions to be inferior to radiography in detecting pneumonia.3

Posterior-anterior (top) and lateral (bottom) chest radiographs showing right upper lobe consolidation in a patient with community acquired pneumonia

How common is community acquired pneumonia?

The annual incidence of community acquired pneumonia in the United Kingdom is 5-11 cases per 1000 adult population.4 Incidence data cannot be extrapolated to other populations because health care varies greatly worldwide. The incidence of the disease varies with age, being higher in very young …

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