Controversies in diagnosis and management of community-acquired pneumonia

Summary

• Community-acquired pneumonia (CAP) is a common condition; however, it appears to be overdiagnosed.
• Diagnosing CAP too frequently may be adding to the problems of overuse of antibiotics, such as bacterial resistance in the community and greater costs and complications in individuals.
• Data support that most patients with non-severe CAP can be treated for 3–5 days; however, most patients with CAP are receiving much longer courses of therapy.
• Macrolides such as azithromycin have the potential to prolong the QT interval, although large population studies show that this does not appear to result in excess cardiac mortality.
• CAP is associated with an increase in a variety of cardiac complications, most notably infarctions and worsening cardiac failure, so clinicians should be vigilant for signs and symptoms of these complications, particularly in patients with a history of ischaemic cardiac disease or the presence of cardiac risk factors.
• Cardiac risk factors should be assessed and managed in patients with CAP over 40 years of age, although there are yet to be data to show that this approach reduces deaths.
• Corticosteroids may have a slight effect on reducing deaths in patients with severe CAP, but this must be balanced against the significant potential for side effects.