Managing pneumonia acquired in nursing homes: special concerns.

Lower respiratory tract infections are a significant cause of morbidity and mortality in the elderly nursing home population. Because the signs and symptoms of pneumonia in this population are frequently atypical, the clinician must maintain a low threshold for instituting therapy. In most cases the pathogenetic organism cannot be identified early in the course of the illness, necessitating the use of empiric, broad-spectrum antibiotic therapy. With the proper use of antibiotics and the resources available at most nursing homes, many patients with pneumonia probably can be successfully treated without the need for hospitalization.