Severe community-acquired pneumonia: current management and future therapeutic alternatives

ABSTRACT

Introduction: Despite advances in modern medicine, severe community-acquired pneumonia (CAP) continues to be a potentially deadly disease. Mortality rate reaches up to the 50% in patients requiring admission to the Intensive Care Unit (ICU) when developing septic shock.

Areas covered: We aim to describe the optimal management of severe CAP, including antibiotic therapy, future antimicrobial options, and non-antibiotic (so-called adjunctive) therapies. A literature search was performed to identify all clinical trials, observational studies, meta-analysis, and reviews about this topic from PubMed.

Expert commentary: Antibiotic therapy, the cornerstone of the management of CAP, must be started prompt because the delay in the administration of antimicrobials is associated with mortality. Diverse observational studies have reported a lower adjusted mortality in patients with severe CAP treated with combined antibiotic therapy, especially those in septic shock or with pneumococcal bacteremia. We summarize the available information about new antibiotics in the pipeline for severe CAP. Finally, we review the available evidence about the role of corticosteroids, immunoglobulins, and statins as adjunctive for CAP.

KEYWORDS:

• Community-acquired pneumonia
• antimicrobial therapy
• combination therapy
• corticosteroids
• immunoglobulins

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Review of disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The manuscript was not funded.