Community-acquired pneumonia (CAP) is changing. The emergence and spread of antibiotic resistance in common causative bacteria, the development of new microbiological diagnostic techniques, new understandings in the area of severity assessment and the development of new antibiotics are just some of the issues. Methods of guideline writing have also evolved 1. The categorisation of evidence and the strength attributed to recommendations are perhaps the most important additions to this methodology 2. Some aspects of the older guidelines for CAP management may therefore be out of date 35.
The publication of the British Thoracic Society (BTS) 6 and American Thoracic Society (ATS) Guidelines for the management of CAP 7 in 2001 and the Canadian 8, 9 and The Infectious Disease Society of North America (IDSA) Guidelines 10 in 2000 were most welcome. They all updated or revised earlier publications (after intervals of 8, 8, 7 and 2 yrs, respectively) and attempted to take account of the issues mentioned above. The scope of each document is similar and they include issues such as clinical presentation and diagnosis, microbial and nonmicrobial investigation and general and antibiotic management. A separate publication confined to antibiotic recommendations was presented by the Centers for Disease Control and Prevention 11. It is not the purpose of this paper to compare these documents item by item, but more to assess in general terms, their potential value and limitations and how and where they may or may not be used.
Guidelines are, whether we …