The JRS guideline for the management of pneumonia in adults 2024

The Japanese Respiratory Society published the Adult Pneumonia Practice Guidelines 2024 in April 2024. In Japan, a super-aged society, the disease burden of pneumonia is significant and is expected to grow in the future. Given this historical context, the most important themes in this revision of the guidelines include the appropriate use of antibiotics and measures against pneumonia in older adults. A large portion of these cases involves aspiration pneumonia, making it challenging to achieve fundamental improvement with antibiotic treatment alone and necessitating a comprehensive approach. Preventing pneumonia and maintaining physical function are essential points for improving the prognosis of pneumonia in older adults, with an emphasis on promoting vaccination, rehabilitation, and oral care. The treatment of Nursing and Healthcare-Associated Pneumonia (NHCAP), a Japan-specific category adapted from the ATS/IDSA's HCAP guidelines, has been extensively reviewed. Despite international moves away from HCAP due to concerns about the overuse of broad-spectrum antibiotics, Japan has chosen to retain NHCAP for treating pneumonia in older adults while implementing stricter controls on antibiotic use to promote antimicrobial stewardship. In cases of repeated aspiration pneumonia or in situations where the patient is in a terminal state of age-related decline or the final stage of comorbidities, all pneumonia patients are recommended to undergo a background assessment, occasionally prioritizing palliative care and respecting the patient's outlook on life. The importance of advanced care planning has also been highlighted to underscore the need for interdisciplinary collaboration with medical doctors and other healthcare professionals.