Community-acquired pneumonia
Also known as: CAP · pneumonia
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Diagnosis and Management of Community-acquired Pneumonia: An Official American Thoracic Society Clinical Practice Guideline
American Thoracic Society (ATS) · 2025
This targeted ATS guideline addresses four questions in adult community-acquired pneumonia — two carried forward from the 2019 ATS/IDSA guideline and two new. It supplements rather than fully replaces the 2019 document, which IDSA still lists as current.
ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia
ERS/ESICM/ESCMID/ALAT · 2023
The first international guideline dedicated to severe community-acquired pneumonia in adults requiring intensive care, developed jointly by four societies using GRADE. It answers eight clinical questions spanning diagnosis, respiratory support and antimicrobial therapy.
- The panel addresses rapid molecular diagnostics, choice of combination antibiotic therapy, and biomarker-guided shortening of treatment duration. source
- Separate questions cover oxygenation strategies, antivirals in confirmed influenza, adjunctive corticosteroids in shock, and aspiration pneumonia. source
US vs EU key differences
- Scope differs: the 2025 ATS guideline covers CAP across all settings (outpatient, ward, ICU), while the ERS/ESICM/ESCMID/ALAT document is restricted to severe CAP, which it defines pragmatically as CAP requiring ICU admission. source
- Corticosteroid triggers differ: ATS 2025 conditionally suggests systemic corticosteroids for hospitalised patients with severe CAP generally, whereas the European guideline restricts them to severe CAP with shock and suggests methylprednisolone 0.5 mg/kg every 12 h for 5 days. source
- ATS 2025 makes duration setting-dependent: under 5 days (minimum 3) for outpatients and non-severe inpatients, but 5 days or more for severe CAP; the European guideline instead leans on procalcitonin-guided shortening rather than a fixed day count. source
- The European guideline explicitly ranks a macrolide ahead of a fluoroquinolone as the add-on to a beta-lactam in severe CAP, citing lower observed mortality; the 2025 ATS update did not revisit that head-to-head choice, focusing instead on imaging, viral-PCR-driven antibiotic decisions, duration and steroids. source
- Only the US guideline addresses imaging modality, suggesting lung ultrasound as an acceptable alternative to chest radiography where local expertise exists (conditional, low certainty). source
What changed recently
- US2019 → 20252025-07-01
The 2025 ATS guideline reverses the 2019 position that every adult with CAP and a positive influenza test should receive antibiotics, now suggesting antibiotics be withheld in otherwise healthy patients with a positive viral test. It also accepts lung ultrasound as an alternative to chest radiography where the preferred imaging is unavailable and staff are trained, supports stopping empiric antibiotics at 48-72 hours in patients with low procalcitonin and early clinical stability, and splits the steroid advice by severity: against systemic corticosteroids in non-severe inpatient CAP, in favour of them in severe CAP.
source ↗curation confidence 90%
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