Community-acquired pneumonia: the evolving challenge

Community-acquired pneumonia (CAP) is a common disorder that has been the f ocus of a major international research effort to define its epidemiology, e tiology and management. The microbial etiology of CAP is complex and severi ty assessment is important in identifying at-risk populations as well as de fining therapeutic strategies. Laboratory investigations rarely influence i nitial therapy, which remains empirical. Guidelines have been developed in many countries in response to the need to optimize management and outcomes. However, many of these guidelines have been based on expert opinion rather than robust evidence. New evidence-based guidelines have been developed th at take into account disease severity, the local distribution of pathogens and their likely susceptibility to antimocrobials, and that include newer t reatment options. Macrolide and fluroquinolone antimicrobials feature heavi ly in these new treatment recommendations. Promising new therapies continue to emerge that may offer advantages over fluroquinolones and macrolides, i n particular with regard to the problem of resistance. Of these, the ketoli des are of special interest. Telithromycin, the first ketolide antibacteria l, has been evaluated in the treatment of >700 patients with CAP. A once-da ily oral dose of telithromycin 800 mg for 7-10 days produces clinical and b acteriological success rates >90% and equivalent to standard comparator age nts, whilst maintaining efficacy against resistant pathogens.