In this episode, I’ll discuss a study that addresses the controversy over giving patients with viral infections antibiotics in the Community Acquired Pneumonia guidelines.
As discussed in episode 1088, new guidelines for treating patients with community-acquired pneumonia were published earlier in 2025 by the American Thoracic Society, but unlike previous versions, these were not endorsed by the Infectious Disease Society of America.
The reason for IDSA’s non-endorsement was because they include two problematic recommendations: One was for the use of antibiotics in outpatients with comorbidities who test positive for respiratory viruses and the second was for inpatients with nonsevere CAP who test positive for respiratory viruses.
In support of this view, a group of authors published in Clinical Infectious Diseases a retrospective study looking at Associations between antibiotic use and outcomes in patients hospitalized with community-acquired pneumonia and positive respiratory viral assays.
The authors retrospectively identified all hospitalized patients with possible CAP and a positive respiratory virus test at five hospitals and used clinical data to propensity-weight patients treated with 0-2 vs. 5-7 days of antibiotics. After propensity weighting, there were no significant differences between groups for length of stay, ICU admission after 48 hours, in-hospital mortality, or 30-day hospital free days.
The authors concluded:
Antibacterial use for patients with possible CAP and respiratory viruses is highly variable but outcomes are similar with 0-2 vs 5-7 days of antibacterials. This suggests antibiotics are not beneficial in most CAP patients who test positive for respiratory viruses.
To be fair, this study was published in IDSA’s journal; however, it is methodologically sound and supports IDSA’s position not to endorse the ATS CAP guidelines.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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