Prevention of community-acquired pneumonia

Preventive measures against CAP are important yet underused. Cost-effective preventive measures against CAP include influenza and pneumococcal vaccines, especially in patients over the age of 65 and other high-risk groups. There are now two antiviral agents, amantadine and rimantadine, that can be used both for prophylaxis and for therapy of influenza A virus infections to decrease the morbidity and mortality of this major predisposer of CAP. Because of fewer side effects, rimantadine should be considered the drug of choice. In selected cases (chronic bronchitis, bronchiectasis, and asplenic patients with poor vaccine response), the early use of antibiotics or prolonged use during winter months may decrease the incidence of lower respiratory infections. Use of monthly gamma globulin infusions in total or selective gamma globulin IgG-deficient patients may be beneficial in reducing the incidence of CAP in selected populations.