The Saudi Thoracic Society evidence-based guidelines for the diagnosis and management of community-acquired pneumonia in children and adults.

Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in children and adults. The burden is especially high among older adults and those with comorbidities. It is also the leading cause of hospital admissions during the annual Islamic pilgrimage (Hajj). CAP is a heterogeneous illness, varying in both etiology and clinical course across different patients. The Saudi Thoracic Society (STS) has developed evidence-based guidelines for the diagnosis, management, and prevention of CAP in both adult and pediatric populations in Saudi Arabia. This is the first guideline of its kind to combine both patient populations in one guideline. Although data on various aspects of CAP - especially within Saudi Arabia - remain limited, the task force based its recommendations on the best available evidence and a structured voting process to answer preset clinical questions. Main highlights from the guidelines include that routine complete blood count may assist in guiding management, particularly in severe disease, while acute-phase reactants (C-reactive protein, procalcitonin) are not recommended at initial diagnosis but may be useful if patients fail to improve. Blood cultures and sputum Gram stain/culture should not be routinely performed, except in severe or deteriorating cases or in hospitalized patients. Respiratory testing for viral pathogens and atypical bacteria is suggested when clinically indicated, especially during outbreaks or in high-risk groups. Chest radiography is recommended in adults and hospitalized children. Short-course antibiotic therapy is favored for improving patients, with early transition from intravenous to oral therapy when hospitalized. Macrolides are preferred over fluoroquinolones in outpatients, while combination beta-lactam plus macrolide therapy is recommended for inpatients. Preventive measures, particularly vaccination, are strongly endorsed. Special considerations apply to elderly, pregnant, chronic obstructive pulmonary disease, and immunocompromised patients. Corticosteroids may benefit select severe cases but are not recommended routinely. These guidelines are intended primarily for general practitioners, emergency physicians, pediatricians, and internal medicine specialists. To enhance accessibility and implementation, STS has simplified the guidelines and provided an executive summary of the key recommendations.