Clinical practice guidelines for the management of pneumonia--do they work?

Significant variation from physician to physician and from hospital to hospital occurs in the management of pneumonia, despite nearly identical patient populations and causative organisms. This situation seems ideal for the use of clinical practice guidelines (CPGs), and several have already been published. The underlying assumptions used to develop pneumonia CPGs need to be examined before further proliferation of pneumonia CPGs. Some issues with pneumonia CPGs are common to all CPGs including the need for validation, especially on a local basis, and the reluctance of practitioners to follow CPGs. Need to adjust antibiotic recommendations based on emerging antibiotic resistance is common to all CPGs for infectious problems. The ability of currently available pneumonia CPGs to affect outcome is suspect because most of the recommendations rely on data that were not outcome-based. Aspects of current pneumonia CPGs are reviewed based on subsequently available data which either validate or question the recommendations.