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Feature Article

Community-acquired pneumonia in adults: current challenges and recommendations

THILINI BASNAYAKE, GRANT WATERER

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Abstract

Evidence is growing that clinical diagnosis of community-acquired pneumonia (CAP) is inaccurate. Viruses are increasingly recognised in patients with CAP, although their significance is often unclear. Prompt initial management is important for patients with CAP, and best outcomes are achieved with a ‘CAP bundle of care’ approach involving early treatment with guideline-concordant antibiotics and early mobilisation. Reducing cardiovascular risk after pneumonia is an emerging challenge.

Key Points

  • Community-acquired pneumonia (CAP) is prevalent, and causative pathogens are evolving over time.
  • The combination of a beta-lactam with a macrolide antibiotic remains the optimal therapy in patients hospitalised with CAP in Australia.
  • Beta-lactam monotherapy, typically amoxicillin, is sufficient for most patients with CAP who are judged suitable for treatment in the community in Australia.
  • Cardiovascular events are common in patients with pneumonia both during the acute illness and in the following six to 12 months, with significant implications for general practice follow up of these patients.
  • There is increasing focus on a ‘CAP bundle of care’ approach to ensure each patient receives optimal care.
  • The benefit of corticosteroid therapy in patients with CAP is a subject of debate; it is currently recommended in patients with critically severe disease (i.e. requiring intensive care).

    Picture credit: © Kevin Somerville/Medical Images

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