Optimal approaches to preventing severe community-acquired pneumonia

ABSTRACT

Introduction: Community-acquired pneumonia (CAP) has the highest rate of mortality of all infectious diseases, especially among the elderly. Severe CAP (sCAP) is defined as a CAP in which intensive care management is required and is associated with an unfavorable clinical course.

Areas covered: This review aims to identify prevention strategies for reducing the incidence of CAP and optimized management of sCAP. We highlight the main prevention approaches for CAP, focusing on the latest vaccination plans and on the influence of health-risk behaviors. Lastly, we report the latest recommendations about the optimal approach for sCAP when CAP has already been diagnosed, including prompt admission to ICU, early empirical antibiotic therapy, and optimization of antibiotic use.

Expert opinion: Despite improvements in the diagnosis and treatment of sCAP, more efforts are needed to combat preventable causes, including the implementation and improvement of vaccine coverage, anti-tobacco campaigns and correct oral hygiene. Moreover, future research should aim to assess the benefits of early antimicrobial therapy in primary care. Pharmacokinetic studies in the target population may help clinicians to adjust dosage regimens in critically ill patients with CAP and thus reduce rates of treatment failure.

KEYWORDS:

• Severe community-acquired pneumonia
• prevention
• vaccine

Article highlights

• Community-acquired pneumonia (CAP), including severe CAP, is among the top 10 causes of mortality.

• Health care habits and lifestyle, including avoiding smoking and correct oral care, have an impact on preventing CAP and sCAP.

• Although prevention by pneumococcal vaccination has been widely studied, the vaccination strategy is still under debate.

• Early ICU admission and early empiric antimicrobial therapy are crucial in order to reduce septic shock, the need for mechanical ventilation support, and mortality.

• Optimizing and monitoring antibiotic concentrations in pulmonary tissue may help to achieve appropriate antimicrobial exposure.

Declaration of interest

A Torres has received grants and/or speaker’s bureau fees and/or grant funding from Bayer Healthcare, MedImmune, Cubist, Pfizer, Theravance, Roche, Polyphor Ldt, GSK, and Astra Zeneca. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

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

Additional information

Funding

This manuscript has not been funded.