Topic
Pneumonia
Antibiotic choice, duration, and corticosteroids in severe disease.
What the evidence shows
Corticosteroids help in severe disease. Hydrocortisone roughly halved 28-day mortality in severe community-acquired pneumonia treated in intensive care, from 11.9% to 6.2% (CAPE COD). The severity threshold is the boundary that matters when generalising this to the ward.
Short courses are enough. Eight days of antibiotics matched fifteen for ventilator-associated pneumonia, with four more antibiotic-free days and no excess mortality or recurrence — except in non-fermenting gram-negative infection, the caveat that still appears in every guideline (PneumA). Note the condition attached: participants had received appropriate initial empirical therapy.
Corticosteroids in severe pneumonia
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| CAPE COD | 2023 | Hydrocortisone | Hydrocortisone roughly halved 28-day mortality in severe community-acquired pneumonia |
Diagnosing ventilator-associated pneumonia
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| CCCTG VAP | 2006 | Endotracheal aspiration | Invasive quantitative sampling gave no advantage over a simple endotracheal aspirate |
Duration of antibiotic therapy
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| PneumA | 2003 | Short-course antibiotics | Eight days of antibiotics matched fifteen for ventilator-associated pneumonia, except in non-fermenting gram-negatives |
Key references
Guidelines, standards and reviews for this topic.
- Community Acquired Pneumonia - Treatment
- Jones BE, Ramirez JA, Oren E, et al. Diagnosis and Management of Community-acquired Pneumonia: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2026 Jan 1;212(1):24-44. PMID 40679934
- Klompas M, Al-Hasan M, Al Mohajer M, et al. Infectious Diseases Society of America (IDSA) Position Statement: Why IDSA Did Not Endorse the Community-Acquired Pneumonia Guidelines 2025 Update. Clin Infect Dis 2026 Apr 30;82(4):622-624. PMID 41340493
- Fungal Pneumonia
- Azar MM. A Diagnostic Approach to Fungal Pneumonia: An Infectious Diseases Perspective. Chest 2024 Mar;165(3):559-572. PMID 37813181
- Hage CA, Carmona EM, Epelbaum O, et al. Microbiological Laboratory Testing in the Diagnosis of Fungal Infections in Pulmonary and Critical Care Practice. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2019 Sep 1;200(5):535-550. PMID 31469325
- Radiographic Resolution
- Mittl RL Jr, Schwab RJ, Duchin JS, et al. Radiographic resolution of community-acquired pneumonia. Am J Respir Crit Care Med 1994 Mar;149(3 Pt 1):630-5. PMID 8118630
- Treatment
- Kalil AC, Metersky ML, Klompas M, et al. Executive Summary: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016 Sep 1;63(5):575-82. PMID 27521441