The JRS guideline for the management of pneumonia in adults 2024

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation Pub Date : 2025-07-03 DOI:10.1016/j.resinv.2025.06.014

Hiroshi Mukae , Naoki Iwanaga , Nobuyuki Horita , Kosaku Komiya , Takaya Maruyama , Yuichiro Shindo , Yoshifumi Imamura , Kazuhiro Yatera , Yoshihiro Yamamoto , Katsunori Yanagihara , Nobuaki Shime , Kazuyoshi Senda , Hiroshi Takahashi , Futoshi Higa , Tetsuya Matsumoto , Makoto Miki , Shinji Teramoto , Hiroki Tsukada , Masahiro Yoshida , Naoyuki Miyashita

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Abstract

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.

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JRS成人肺炎管理指南2024

日本呼吸学会于2024年4月发布了《成人肺炎实践指南2024》。在超老龄化社会的日本，肺炎的疾病负担很大，预计未来还会增加。鉴于这一历史背景，本次指南修订的最重要主题包括老年人适当使用抗生素和采取措施预防肺炎。这些病例中有很大一部分涉及吸入性肺炎，这使得仅靠抗生素治疗实现根本改善具有挑战性，需要采取综合方法。预防肺炎和维持身体机能是改善老年人肺炎预后的要点，重点是促进疫苗接种、康复和口腔护理。护理和卫生保健相关肺炎（护理和卫生保健相关肺炎）的治疗是根据ATS/IDSA的护理和卫生保健相关肺炎指南改编的日本特定类别，已进行了广泛审查。尽管国际上由于担心广谱抗生素的过度使用而远离HCAP，但日本选择保留NHCAP用于治疗老年人肺炎，同时实施更严格的抗生素使用控制，以促进抗菌药物的管理。在反复吸入性肺炎的病例中，或在患者处于与年龄相关的衰退晚期或合并症的最后阶段的情况下，建议所有肺炎患者接受背景评估，偶尔优先考虑姑息治疗并尊重患者的生活前景。还强调了提前护理规划的重要性，以强调与医生和其他保健专业人员进行跨学科合作的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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