Controversy about the New Guideline on Community-Acquired Pneumonia

In July 2025, the American Thoracic Society (ATS) published an updated guideline on managing community-acquired pneumonia (CAP).¹ Although the guideline was developed initially by members of both ATS and the Infectious Disease Society of America (IDSA), the final version was not endorsed by IDSA. Two essays, written primarily by IDSA members and published in December 2025, explain why.^{2, 3}

The point of disagreement involved antibiotic treatment for patients with CAP who test positive for a respiratory virus — an increasingly common situation, for which strong evidence to support or reject antibiotic therapy is lacking. They were divided into four groups:

• Outpatients without comorbidities

• Outpatients with comorbidities

• Inpatients with non…