Understanding the Natural History of Community-Acquired Pneumonia Resolution: Vital Information for Optimizing Duration of Therapy

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Abstract
New understanding of the management of community-acquired pneumonia (CAP) has led to an interest in defining the optimal duration of antibiotic therapy [1]. Clearly, patients need to receive enough therapy to eradicate the etiologic pathogen and to prevent recurrence, yet not so much therapy that antibiotic resistance develops as a result of the patient being exposed to antimicrobials long after the original organism has been eliminated. It is very likely that the correct duration of therapy will vary from patient to patient, rather than being some arbitrary duration dictated by “local tribal custom” (i.e., 5, 7, 10, and 14 days seem to be popular durations, but no recommendations for 6, 9, 11, or 13 days of therapy have appeared). The clinical response depends on a variety of influences, including host factors (e.g., immune status and comorbid illness), bacteriologic factors (e.g., virulence, susceptibility to available therapies, and inoculum), disease factors (e.g., the extent of illness and physiologic compromise and the degree of disease progression at the time of diagnosis), and therapy factors (e.g., the timing and adequacy of therapy, as well as the pharmacokinetics of the selected agent). Because many of these influences are potentially amenable to intervention, a better understanding of patients' response to CAP therapy could lead to effective efforts to define and optimize the duration of therapy.