Infectious Diseases Society of America (IDSA) Position Statement: Why IDSA Did Not Endorse the Community-Acquired Pneumonia Guidelines 2025 Update

The American Thoracic Society recently released updated community-acquired pneumonia (CAP) guidelines. The Infectious Diseases Society of America (IDSA) agreed with 8 of the 10 recommendations in the guidelines but declined to endorse the guidelines because they include recommendations for use of antibiotics in outpatients with comorbidities and inpatients with nonsevere CAP who test positive for respiratory viruses. It is noted in the guidelines that bacterial coinfections are common and that delaying antibiotics may be harmful. IDSA notes, however, that nondiscriminatory use of antibiotics for patients with CAP and positive viral assays confers more risks than benefits. Most patients do not have bacterial coinfections, and briefly withholding antibiotics for patients with nonsevere illness to clarify the diagnosis is safe. In this era of precision medicine, IDSA instead recommends individualized, dynamic decision-making that takes into account each patient´s evolving trajectory, severity of illness and balance of clinical features for and against coinfection.