Community acquired pneumonia affects over 5 million Americans and 6 million Europeans annually. Typically 5-10% will be admitted to hospital. It is a condition that more often affects the elderly with a commensurately higher mortality rate, which can be as high as 25%. Indeed over 50,000 deaths occur in the USA each year due to this infection. Diagnosis of pneumonia is almost exclusively clinical in terms of signs and symptoms although a positive chest X ray is vital.

Approximately half of all pneumonia infections are caused by bacteria, the remainder are viral in origin. Streptococcus pneumoniae accounts for the majority of the bacterial cases. As with many other bacterial species the pneumococcus is becoming resistant to many of the commonly used antibiotics. As a result the US FDA has re-assigned the infection to be called Community Acquired Bacterial Pneumonia (CABP).

Learned guidelines recommend either a macrolide or a doxycycline as the first choices for the low risk patient or a respiratory fluoroquinolone for those at higher risk or who have failed an initial course. Resistance to both first line agents is increasing in the USA   leading to a growing list of adverse consequences such as emergency room visits, hospitalization or re-admission to hospital. This presentation will review the current knowledge of the disease and the challenges of managing these patients.

Learning Objective 1 : to appreciate the escalating burden of CABP in the USA

Learning Objective 2 : to understand the impact antibiotic resistance can have in CABP

Learning Objective 3 : to understand the current challenges in managing CABP