We Dissent: Lessons From the 2025 Community-Acquired Pneumonia (CAP) Guidelines.

Abstract

Clinical practice guidelines profoundly influence patient care, making transparency, rigor, and fairness in their development essential. The 2025 community-acquired pneumonia (CAP) guideline update, developed by the American Thoracic Society (ATS) and initially co-sponsored by the Infectious Diseases Society of America (IDSA), included a recommendation to prescribe antibacterials for CAP upon detection of a respiratory viral pathogen. Here, we acknowledge the guidelines' strengths with respect to supporting shorter treatment duration but highlight the lack of supporting data for antibacterial therapy in CAP with a respiratory virus. We additionally reflect on shortcomings in the guideline development process itself, which may have led to this recommendation, including meeting logistics, communication, and methodology, using these observations to offer suggestions for future infectious diseases guidelines panels. Despite the unfortunate outcome, we commend IDSA for their difficult but principled decision to withdraw support, preserving stewardship priorities and the commitment to first do no harm.