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Review
. 2025 Nov 15;406(10517):2371-2388.
doi: 10.1016/S0140-6736(25)01493-X. Epub 2025 Oct 16.

Community-acquired pneumonia

Luis Felipe Reyes  1 , Andrew Conway Morris  2 , Cristian Serrano-Mayorga  3 , Lennie P G Derde  4 , Robert P Dickson  5 , Ignacio Martin-Loeches  6
Affiliations
Review

Community-acquired pneumonia

Luis Felipe Reyes et al. Lancet. .

Abstract

Community-acquired pneumonia is a major global health challenge that disproportionately affects vulnerable populations, including older people, immunocompromised people, those with chronic conditions, and young children. Once considered solely an acute illness, community-acquired pneumonia is now recognised as a disease with long-term complications, including cardiovascular events, respiratory impairment, and cognitive decline. Advances, such as nucleic acid amplification tests (NAATs) and the broader availability of point-of-care lung ultrasound, allow for rapid pathogen detection and personalised treatment. However, substantial uncertainties remain regarding the role of NAATs, lung ultrasounds, and serum biomarkers in clinical practice. Antibiotics are the cornerstone of community-acquired pneumonia treatment, but the roles of adjunctive therapies, including corticosteroids and immunomodulators, remain incompletely defined. Comprehensive community-acquired pneumonia management emphasises personalised treatment, rehabilitation after the acute episode, routine cardiovascular screening, and strengthening preventive measures, such as vaccination. As precision medicine advances, integrating diagnostics and tailored therapies will improve outcomes and reduce the global burden of community-acquired pneumonia.

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Conflict of interest statement

Declaration of interests LFR reports grants or contracts from GSK, Pfizer, and MSD; consulting fees from GSK and Pfizer; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from GSK and Pfizer; payment for expert testimony from GSK and Pfizer; and support for attending meetings and/or travel from GSK and Pfizer. ACM reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Biomerieux, Fischer and Paykel, ThermoFisher, and Boston Scientific, and participation on a Data Safety Monitoring Board or Advisory Board for Cambridge Infection Diagnostics. CS-M reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Pfizer and support for attending meetings and/or travel from Pfizer. LPGD reports grants or contracts from Horizon 2020; support for attending meetings and/or travel from the European Society of Intensive Care Medicine (ESICIM), the International Symposium on Intensive Care and Emergency Medicine, the European Respiratory Society, and the University of Pittsburgh Medical Center; and a leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid with WHO, ESICIM, the European Clinical Research Alliance for Infectious Diseases, and the Dutch Society for Intensive Care Medicine. IM-L reports consulting fees from Mundipharma and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from MSD and Gilead. RPD declares no competing interests.

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