Current treatment considerations in community-acquired pneumonia in older patients

The incidence of community-acquired pneumonia (CAP) increases markedly in older individuals (age >65 years), among whom the principal risk factor for CAP is chronic underlying disease. Streptococcus pneumoniae (pneumococcus) is the main cause of CAP in this age group, although atypical organisms may also have important pathogenic roles. Several features of the clinical presentation of CAP in older patients are unique to the elderly, and patients with a complicated course of illness and several risk factors for mortality should be hospitalised. In both inpatients and outpatients, initial antibacterial therapy should be empirical. Recent research indicates that older patients with CAP who are not severely ill can receive initial, empirical monotherapy with a once daily preparation such as a new third-generation fluoroquinolone or a new macrolide. In hospital, intravenous (IV) antibacterial therapy should be replaced by oral therapy, and early discharge considered, as soon as the patient's condition permits.