ATS updates guideline on community-acquired pneumonia

The American Thoracic Society (ATS) released a new clinical guideline on treatment of community-acquired pneumonia (CAP).

The new guideline, which was developed by experts from the ATS and the Infectious Diseases Society of America but only approved by the ATS, is intended to update a 2019 joint guideline from the two societies. Care of CAP has been affected by many factors since 2019, including the

COVID-19 pandemic, developments in rapid molecular tests and imaging technology, and new evidence about the role of corticosteroids, noted the introduction to the guideline, which was published by the Journal of Respiratory and Critical Care Medicine on July 18.

For adult outpatients without comorbidities who have clinical and imaging evidence of CAP and who test positive for a respiratory virus, it is suggested not to prescribe empiric antibiotics (conditional recommendation, very low-quality evidence). For those with comorbidities, empiric antibiotics are suggested due to concern for bacterial-viral co-infection (conditional recommendation, very low-quality evidence).

For adult outpatients with CAP who reach clinical stability, less than five days of antibiotics (minimum of three days) is suggested over five or more days of antibiotics (conditional recommendation, low-quality evidence).

The guideline also addresses diagnostics, suggesting lung ultrasound is as an acceptable diagnostic alternative to chest X-ray for suspected CAP in medical centers where appropriate clinical expertise exists (conditional recommendation, low-quality evidence). Guidance on inpatient care offers recommendations on use and duration of antibiotics and corticosteroids in nonsevere and severe CAP.

The guideline is not intended to apply to immunocompromised patients, and its application to patients with COVID-19 pneumonia is still uncertain, the authors said.

“Given the potential impact of future research on our current recommendations, it is crucial for physicians to thoroughly assess patients when implementing a clinical approach based on these recommendations and to individualize their management according to patients' risks and clinical response. We encourage a nuanced clinical approach to pneumonia care that acknowledges the complexity of lung disease and uncertainty in the evidence base,” the guidelines concluded.