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Community acquired pneumonia

Last edited: 4/13/2026

Overview

Community-acquired pneumonia (CAP) is an infection of the lung parenchyma acquired outside of hospital settings, often caused by bacteria, viruses, or fungi, leading to significant morbidity and mortality 1310.

Diagnosis

  • Clinical Presentation: Fever, cough, pleuritic chest pain, dyspnea 1.
  • Physical Examination: Vital signs, breath sounds, and signs of consolidation or pleural effusion 1.
  • Diagnostic Tests:
    • - Chest X-ray: Essential for confirming lung involvement 1. - Blood Tests: Complete blood count (elevated WBC), C-reactive protein (elevated), blood cultures 1. - Sputum Culture: To identify causative organisms 1. - Pneumococcal Urinary Antigen Test: Useful in HIV-1 patients 44.
  • Severity Grading: CURB65 score (confusion, respiratory rate ≥30/min, blood urea nitrogen ≥16 mg/dL, systolic BP ≤90 mmHg, age ≥65 years) 155.

    • Management

  • Antibiotics:
    • - First-line: Amoxicillin for non-severe CAP in non-allergic patients 1. - Alternative: Ceftriaxone or a macrolide (e.g., azithromycin) for severe CAP or in cases of suspected atypical pathogens 11159. - Special Considerations: Omadacycline for resistant strains 2, consider coverage for specific pathogens based on local resistance patterns 12.
  • Supportive Care: Oxygen therapy, hydration, and monitoring of organ function 1.
  • Corticosteroids: May be beneficial in severe CAP to reduce mortality and improve outcomes 1146.
  • Vitamin D Supplementation: Consider in deficient patients to potentially improve outcomes 89.

    • Special Populations

  • Elderly: Increased risk of complications; CURB65 score crucial for severity assessment 11461.
  • Pediatrics: Many previously healthy children under 3 years may not require antibiotics for uncomplicated cases 15.
  • Comorbidities: COPD patients may have specific pathogens like pneumococci 12; tailored antibiotic therapy advised.

    • Key Recommendations

  • Use CURB65 Score for Severity Assessment: Helps in guiding hospitalization and ICU admission decisions 155 (Evidence: Strong).
  • Initiate Appropriate Antibiotics Early: Tailor based on severity and local resistance patterns 111 (Evidence: Strong).
  • Consider Corticosteroids in Severe Cases: To potentially reduce mortality and improve clinical outcomes 1146 (Evidence: Moderate).
  • Evaluate and Supplement Vitamin D in Deficient Patients: May improve outcomes 89 (Evidence: Moderate).
  • Avoid Unnecessary Antibiotic Use in Low-Risk Pediatric Patients: Many previously healthy young children may not require antibiotics 15 (Evidence: Moderate).

    • References

    1 Jones BE, Ramirez JA, Oren E, Soni NJ, Sullivan LR, Restrepo MI et al.. Diagnosis and Management of Community-acquired Pneumonia: An Official American Thoracic Society Clinical Practice Guideline. American journal of respiratory and critical care medicine 2026. link 2 Zhao YL, Qu Q, Wang YM, Zhang YT, Qu J. A disproportionality analysis of adverse events associated with omadacycline based on the FDA adverse event reporting system database. The Journal of antimicrobial chemotherapy 2026. link 3 Dinh A, Barbier F, Bedos JP, Blot M, Cattoir V, Claessens YE et al.. Update of guidelines for management of Community Acquired pneumonia in adults by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF): Endorsed by the French intensive care society (SRLF), the French microbiology society (SFM), the French radiology society (SFR) and the French emergency society (SFMU). Respiratory medicine and research 2025. link 4 Kulik L, Ramon D. Coping with role conflict and maintaining work self-efficacy: Strategies for working mothers during community emergencies. Journal of emergency management (Weston, Mass.) 2025. link 5 Zhang Z, He J, Liang Y, Wang Y, Zheng J, Ma L et al.. Adverse events associated with azithromycin and clarithromycin in adults aged ≥65: a disproportionality analysis of the FDA Adverse Event Reporting System (FAERS) database. Expert opinion on drug safety 2025. link 6 van der Lee L, Patman S, Hill AM. Development of a clinical practice guideline for physiotherapy management of adults invasively ventilated with community-acquired pneumonia. Physiotherapy 2024. link 7 Pan X, Guo X, Shi J. Design of a novel multiepitope vaccine with CTLA-4 extracellular domain against Mycoplasma pneumoniae: A vaccine-immunoinformatics approach. Vaccine 2024. link 8 Garg D, Bhalla K, Nanda S, Gupta A, Mehra S. Vitamin D status in children with community acquired pneumonia and its association with severity: a hospital-based study. Minerva pediatrics 2024. link 9 Sharma Y, Mangoni AA, Horwood C, Thompson C. Association Between Multivitamin Use on Admission and Clinical Outcomes in Patients Hospitalised with Community-Acquired Pneumonia: A Case-Cohort Study. Nutrients 2024. link 10 Wang M, Liu H, Chen Y, Yu J, Lin J, Sun Z et al.. Guideline on treating community-acquired pneumonia with Chinese patent medicines. Pharmacological research 2023. link 11 Pitre T, Abdali D, Chaudhuri D, Pastores SM, Nei AM, Annane D et al.. Corticosteroids in Community-Acquired Bacterial Pneumonia: a Systematic Review, Pairwise and Dose-Response Meta-Analysis. Journal of general internal medicine 2023. link 12 Kim JY, Jung JW, Kang MJ, Kim DK, Choi H, Cho YJ et al.. The serotype-specific prevalence of pneumococci in hospitalized pneumonia patients with COPD: a prospective, multi-center, cohort study. The Korean journal of internal medicine 2023. link 13 Amorim AAL, Alvarenga KF, Jacob LCB, Araújo ES. Usability evaluation of the Agente Escuta application: translational research. CoDAS 2023. link 14 Clotet-Vidal S, Saez Prieto ME, Duch Llorach P, Gutiérrez ÁS, Casademont Pou J, Torres Bonafonte OH. Malnutrition, Functional Decline, and Institutionalization in Older Adults after Hospital Discharge Following Community-Acquired Pneumonia. Nutrients 2023. link 15 Rosenberg K. Antibiotics Not Needed in Many Children with Community-Acquired Pneumonia. The American journal of nursing 2022. link 16 Raven J, Wurie H, Baba A, Bah AJ, Dean L, Hawkins K et al.. Supporting community health workers in fragile settings from a gender perspective: a qualitative study. BMJ open 2022. link 17 Er AG, Alonso AAR, Marin-Leon I, Sayiner A, Bassetti S, Demirkan K et al.. Community-acquired pneumonia - An EFIM guideline critical appraisal adaptation for internists. European journal of internal medicine 2022. link 18 Ao XX. The epidemiology of hospital death following pediatric severe community acquired pneumonia. Italian journal of pediatrics 2021. link 19 Coutinho A, Riaz A, Makan A, Crawford E, Dev D, Srinivasan K et al.. Lessons of the month: Co-infection with SARS-CoV-2 and influenza B virus in a patient with community-acquired pneumonia. Clinical medicine (London, England) 2020. link 20 Cillóniz C, Dominedò C, Pericàs JM, Rodriguez-Hurtado D, Torres A. Community-acquired pneumonia in critically ill very old patients: a growing problem. European respiratory review : an official journal of the European Respiratory Society 2020. link 21 Secrest MH, Platt RW, Dormuth CR, Chateau D, Targownik L, Nie R et al.. Extreme restriction design as a method for reducing confounding by indication in pharmacoepidemiologic research. Pharmacoepidemiology and drug safety 2020. link 22 Pick HJ, Bolton CE, Lim WS, McKeever TM. Patient-reported outcome measures in the recovery of adults hospitalised with community-acquired pneumonia: a systematic review. The European respiratory journal 2019. link 23 Le Bel J, Pelaccia T, Ray P, Mayaud C, Brun AL, Hausfater P et al.. Impact of emergency physician experience on decision-making in patients with suspected community-acquired pneumonia and undergoing systematic thoracic CT scan. Emergency medicine journal : EMJ 2019. link 24 Guo Q, Song WD, Li HY, Zhou YP, Li M, Chen XK et al.. Scored minor criteria for severe community-acquired pneumonia predicted better. Respiratory research 2019. link 25 Wang T, Hou Y, Wang R. A case report of community-acquired Pseudomonas aeruginosa pneumonia complicated with MODS in a previously healthy patient and related literature review. BMC infectious diseases 2019. link 26 Florin TA, Brokamp C, Mantyla R, DePaoli B, Ruddy R, Shah SS et al.. Validation of the Pediatric Infectious Diseases Society-Infectious Diseases Society of America Severity Criteria in Children With Community-Acquired Pneumonia. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2018. link 27 Horwood CM, Hakendorf P, Thompson CH. Comparison of specialist and generalist care. Australian health review : a publication of the Australian Hospital Association 2018. link 28 Rafat C, Messika J, Barnaud G, Dufour N, Magdoud F, Billard-Pomarès T et al.. Hypervirulent Klebsiella pneumoniae, a 5-year study in a French ICU. Journal of medical microbiology 2018. link 29 Feldman C, Anderson R. Pneumonia as a systemic illness. Current opinion in pulmonary medicine 2018. link 30 Magira EE, Zakynthinos S. Legionnaire's Disease and Influenza. Infectious disease clinics of North America 2017. link 31 Lara B, Cañas F, Vidal A, Nadal N, Rius F, Paredes E et al.. Knowledge management through two virtual communities of practice (Endobloc and Pneumobloc). Health informatics journal 2017. link 32 Stuck AR, Crowley C, Killeen J, Castillo EM. National Survey of Emergency Physicians Concerning Home-Based Care Options as Alternatives to Emergency Department-Based Hospital Admissions. The Journal of emergency medicine 2017. link 33 Lim WS, Rodrigo C, Turner AM, Welham S, Calvert JM. British Thoracic Society community-acquired pneumonia care bundle: results of a national implementation project. Thorax 2016. link 34 Menéndez R, Montull B, Reyes S, Amara-Elori I, Zalacain R, Capelastegui A et al.. Pneumonia presenting with organ dysfunctions: Causative microorganisms, host factors and outcome. The Journal of infection 2016. link 35 Salih W, Schembri S, Chalmers JD. Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data. The European respiratory journal 2014. link 36 Lim HF, Phua J, Mukhopadhyay A, Ngerng WJ, Chew MY, Sim TB et al.. IDSA/ATS minor criteria aid pre-intensive care unit resuscitation in severe community-acquired pneumonia. The European respiratory journal 2014. link 37 Salluh JI, Lisboa T, Bozza FA, Soares M, Póvoa P. Management of severe community-acquired pneumonia: a survey on the attitudes of 468 physicians in Iberia and South America. Journal of critical care 2014. link 38 Almatar MA, Peterson GM, Thompson A, Zaidi ST. Factors influencing ceftriaxone use in community-acquired pneumonia: Emergency doctors' perspectives. Emergency medicine Australasia : EMA 2014. link 39 Watanabe A, Goto H, Kohno S, Matsushima T, Abe S, Aoki N et al.. Nationwide survey on the 2005 Guidelines for the Management of Community-Acquired Adult Pneumonia: validation of severity assessment. Respiratory investigation 2012. link 40 Watanabe A, Goto H, Kohno S, Matsushima T, Abe S, Aoki N et al.. Nationwide survey on the 2005 Guidelines for the Management of Community-Acquired Adult Pneumonia: validation of differentiation between bacterial pneumonia and atypical pneumonia. Respiratory investigation 2012. link 41 Sims SA, Dale JA, Johnson TJ, Christensen K, Ward E. Electronic quality measurement predicts outcomes in community acquired pneumonia. AMIA ... Annual Symposium proceedings. AMIA Symposium 2012. link 42 Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C et al.. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2011. link 43 Choudhury G, Chalmers JD, Mandal P, Akram AR, Murray MP, Short P et al.. Physician judgement is a crucial adjunct to pneumonia severity scores in low-risk patients. The European respiratory journal 2011. link 44 Perelló R, Miró O, Miró JM, Massó E, Sánchez M, Camón S et al.. Urgent pneumococcal urinary antigen, importance in the diagnosis of acquired pneumonia in HIV-1 patients. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2011. link 45 Tada Y, Taniguchi A, Nagao I, Miki T, Uematsu M, Tsuda A et al.. Differing growth responses of major phylogenetic groups of marine bacteria to natural phytoplankton blooms in the western North Pacific Ocean. Applied and environmental microbiology 2011. link 46 Salluh JI, Soares M, Coelho LM, Bozza FA, Verdeal JC, Castro-Faria-Neto HC et al.. Impact of systemic corticosteroids on the clinical course and outcomes of patients with severe community-acquired pneumonia: a cohort study. Journal of critical care 2011. link 47 Huff C. Community partnerships. Trustee : the journal for hospital governing boards 2010. link 48 Medow MA, Arkes HR, Shaffer VA. Are residents' decisions influenced more by a decision aid or a specialist's opinion? A randomized controlled trial. Journal of general internal medicine 2010. link 49 Toyoshima M, Chida K, Suda T. Fulminant community-acquired pneumonia probably caused by Acinetobacter lwoffii. Respirology (Carlton, Vic.) 2010. link 50 File TM. Case studies of lower respiratory tract infections: community-acquired pneumonia. The American journal of medicine 2010. link 51 Bewick T, Cooper VJ, Lim WS. Does early review by a respiratory physician lead to a shorter length of stay for patients with non-severe community-acquired pneumonia?. Thorax 2009. link 52 Nicks BA, Manthey DE, Fitch MT. The Centers for Medicare and Medicaid Services (CMS) community-acquired pneumonia core measures lead to unnecessary antibiotic administration by emergency physicians. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2009. link 53 Gérard HC, Fomicheva E, Whittum-Hudson JA, Hudson AP. Apolipoprotein E4 enhances attachment of Chlamydophila (Chlamydia) pneumoniae elementary bodies to host cells. Microbial pathogenesis 2008. link 54 Aliberti S, Amir A, Peyrani P, Mirsaeidi M, Allen M, Moffett BK et al.. Incidence, etiology, timing, and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia. Chest 2008. link 55 Lim WS. Severity assessment in community-acquired pneumonia: moving on. Thorax 2007. link 56 Fee C, Weber EJ. Identification of 90% of patients ultimately diagnosed with community-acquired pneumonia within four hours of emergency department arrival may not be feasible. Annals of emergency medicine 2007. link 57 . Management of community-acquired pneumonia in adults. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 2007. link 58 Dremsizov T, Clermont G, Kellum JA, Kalassian KG, Fine MJ, Angus DC. Severe sepsis in community-acquired pneumonia: when does it happen, and do systemic inflammatory response syndrome criteria help predict course?. Chest 2006. link 59 Menéndez R, Torres A, Zalacaín R, Aspa J, Martín-Villasclaras JJ, Borderías L et al.. Guidelines for the treatment of community-acquired pneumonia: predictors of adherence and outcome. American journal of respiratory and critical care medicine 2005. link 60 Confalonieri M, Urbino R, Potena A, Piattella M, Parigi P, Puccio G et al.. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. American journal of respiratory and critical care medicine 2005. link 61 Torres OH, Muñoz J, Ruiz D, Ris J, Gich I, Coma E et al.. Outcome predictors of pneumonia in elderly patients: importance of functional assessment. Journal of the American Geriatrics Society 2004. link 62 Schultz TR. On the trail of community-acquired pneumonia. Recognize the early signs of this respiratory infection to pinpoint effective treatment plan. Nursing management 2003. link 63 Kaneko Y, Takano T, Nakamura K. Visual localisation of community health needs to rational decision-making in public health services. Health & place 2003. link00056-4) 64 Loeb MB. Community-acquired pneumonia in older people: the need for a broader perspective. Journal of the American Geriatrics Society 2003. link 65 Clermont G, Angus DC, Linde-Zwirble WT, Griffin MF, Fine MJ, Pinsky MR. Does acute organ dysfunction predict patient-centered outcomes?. Chest 2002. link 66 . Standardized treatment cuts pneumonia deaths. Hospital case management : the monthly update on hospital-based care planning and critical paths 2001. link 67 . Clinical policy for the management and risk stratification of community-acquired pneumonia in adults in the emergency department. Annals of emergency medicine 2001. link 68 Marik PE, Iglesias J. Severe community-acquired pneumonia, shock and multiorgan dysfunction syndrome caused by Chlamydia pneumoniae. Journal of internal medicine 1997. link 69 Rudner N. Working with community health advisors as part of the community health team. Journal of public health management and practice : JPHMP 1996. link 70 Fortune G, Elder S, Jaco D, Bentivegna P, Luebbering T, Boechler M. Opportunities for improving the care of patients with community-acquired pneumonia. Clinical performance and quality health care 1996. link 71 Brown RB. Community-acquired pneumonia: diagnosis and therapy of older adults. Geriatrics 1993. link 72 Ritchie RF, Rippey JH. Performance on immunoglobulin IgG, IgA, and IgM tests in CAP survey specimens. American journal of clinical pathology 1982. link

    Original source

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      Update of guidelines for management of Community Acquired pneumonia in adults by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF): Endorsed by the French intensive care society (SRLF), the French microbiology society (SFM), the French radiology society (SFR) and the French emergency society (SFMU). — Dinh A, Barbier F, Bedos JP, Blot M, Cattoir V, Claessens YE et al. Respiratory medicine and research (2025)
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      Impact of emergency physician experience on decision-making in patients with suspected community-acquired pneumonia and undergoing systematic thoracic CT scan. — Le Bel J, Pelaccia T, Ray P, Mayaud C, Brun AL, Hausfater P et al. Emergency medicine journal : EMJ (2019)
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      Validation of the Pediatric Infectious Diseases Society-Infectious Diseases Society of America Severity Criteria in Children With Community-Acquired Pneumonia. — Florin TA, Brokamp C, Mantyla R, DePaoli B, Ruddy R, Shah SS et al. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2018)
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