Earlier this summer, the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) released an update to their 2019 guideline, Diagnosis and Treatment of Adults with Community-acquired Pneumonia. The 2025 update, now titled Diagnosis and Management of Community-Acquired Pneumonia, reflects new evidence and clinical considerations that have emerged since the previous guideline's publication.
A panel of multidisciplinary experts from both the ATS and IDSA came together to identify key interventions for community-acquired pneumonia that warranted a review of the evidence.
For the new update, the panel addressed four clinically relevant questions, with two being updates from the previous 2019 guideline in addition to two new questions.
The following overview compares changes between the 2019 and 2025 ATS/ISDA guidelines regarding community-acquired pneumonia in adult patients.
Guidelines Referenced
Diagnosis and Management of Community-Acquired Pneumonia
Diagnosis and Treatment of Adults with Community-acquired Pneumonia
- October 2019
- Full Text
Major Changes and Key Takeaways (2019-2025)
The following table reflects the new recommendations added in the 2025 update. To view unchanged recommendations, along with the guidelines themselves, view the full-text guidelines using the links featured above.
| Topic | 2019 Guideline | 2025 Guideline |
|---|---|---|
| Lung Ultrasound Versus Chest X-ray to Diagnose CAP | Not addressed. | For adults with suspected CAP, we suggest lung ultrasound as an acceptable diagnostic alternative to chest x-ray in medical centers where appropriate clinical expertise exists. |
| Empiric Antibacterial Therapy for CAP with Positive Respiratory Virus Testing | Not addressed. | For adult outpatients without comorbidities who have clinical and imaging evidence of CAP and who test positive for a respiratory virus, we suggest not prescribing empiric antibiotics. For adult outpatients with comorbidities who have clinical and imaging evidence of CAP and who test positive for a respiratory virus, we suggest prescribing empiric antibiotics due to concern for bacterial-viral co-infection. For adult inpatients with clinical and imaging evidence of non-severe CAP who test positive for a respiratory virus, we suggest prescribing empiric antibiotics due to concern for bacterial-viral co-infection. For adult inpatients with clinical and imaging evidence of severe CAP who test positive for a respiratory virus, we suggest prescribing empiric antibiotics due to concern for bacterial-viral co-infection. |
| Antibiotic Duration for CAP | We recommend that the duration of antibiotic therapy should be guided by a validated measure of clinical stability (resolution of vital sign abnormalities [heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature], ability to eat, and normal mentation), and antibiotic therapy should be continued until the patient achieves stability and for no less than a total of five days. | For adult outpatients with CAP who reach clinical stability, we suggest less than five days of antibiotics (minimum of three days duration), rather than five or more days of antibiotics. For adult inpatients with non-severe CAP who reach clinical stability, we suggest less than five days of antibiotics (minimum of three days duration), rather than five or more days of antibiotics. For adult inpatients with severe CAP who reach clinical stability, we suggest five or more days of antibiotics, rather than less than five days of antibiotics. |
| Systemic Corticosteroids for CAP | We recommend not routinely using corticosteroids in adults with nonsevere CAP. We suggest not routinely using corticosteroids in adults with severe CAP. We suggest not routinely using corticosteroids in adults with severe influenza pneumonia. | For adult inpatients with non-severe CAP, we recommend not administering systemic corticosteroids. For adult inpatients with severe CAP, we suggest systemic corticosteroids. |
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