In the northern hemisphere about 12/1000 people a year (on average) contract pneumonia while living in the community, with most cases caused by Streptococcus pneumoniae. Mortality ranges from about 5-35% depending on severity of disease, with a worse prognosis in older people, men, and people with chronic diseases.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent community-acquired pneumonia? What are the effects of treatments for community-acquired pneumonia in outpatient settings, in people admitted to hospital, and in people receiving intensive care? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (oral, intravenous), different combinations, and prompt administration of antibiotics in intensive-care settings, early mobilisation, influenza vaccine, and pneumococcal vaccine.
In the northern hemisphere about 12/1000 people a year (on average) contract pneumonia while living in the community, with most cases caused by Streptococcus pneumoniae.
People at greatest risk include those at the extremes of age, smokers, alcohol-dependent people, and people with lung or heart disease or immunosuppression.Mortality ranges from about 5-35% depending on severity of disease, with a worse prognosis in older people, men, and people with chronic diseases.
Deaths from influenza are usually caused by pneumonia. Influenza vaccine reduces the risk of clinical influenza, and may reduce the risk of pneumonia and mortality in elderly people.
Pneumococcal vaccine is unlikely to reduce all-cause pneumonia or mortality in immunocompetent adults, but may reduce pneumococcal pneumonia in this group.
Antibiotics lead to clinical cure in 80% or more of people with pneumonia being treated in the community or in hospital, although no one regimen has been shown to be superior to the others in either setting.
Early mobilisation may reduce hospital stay compared with usual care in people being treated with antibiotics.
Intravenous antibiotics have not been shown to improve clinical cure rates or survival compared with oral antibiotics in people treated in hospital for non-severe community-acquired pneumonia.Continued treatment with oral amoxicillin after initial improvement with intravenous amoxicillin may not improve clinical cure rate compared with intravenous amoxicillin alone.
Prompt administration of antibiotics may improve survival compared with delayed treatment in people receiving intensive care for community-acquired pneumonia, although few studies have been done.
We don't know which is the optimum antibiotic regimen to use in these people.