Review Article Volume 15 Issue 3 - 2026

Deduction and Induction in Solving the Problem of Acute Pneumonia

Igor Klepikov*

MD, Professor, Retired, Renton, WA, USA.

*Corresponding Author: Igor Klepikov, MD, Professor, Retired, Renton, WA, USA.
Received: January 12, 2026; Published: March 04, 2026



The antibiotic era has shaped the currently dominant view of their crucial role in treating patients with AP, attributing the main cause of inflammation to pathogenic microorganisms and their virulence. Prolonged use of antibiotics has led to a number of side effects that complicate the solution to the problem of AP, but not all of them are recognized and discussed. A detailed analysis of existing facts points to profound misconceptions and contradictions in attempts to find an optimal solution to this problem, the results of which continue to worsen. The path to achieving the stated goals in this area of medicine is not only realistic, but has even been successfully and convincingly tested. However, the main barrier, overcoming which requires significant effort, but which must be eliminated, is associated with a radical change in professional perceptions of the essence of the problem.

Keywords: Acute Pneumonia; Etiology; Antibiotics; Side Effect; Pathogenesis; Disease Concept; Emergency Care

  1. Cilloniz C., et al. “World pneumonia day 2024: Fighting pneumonia and antimicrobial resistance”. American Journal of Respiratory and Critical Care Medicine11 (2024): 1283-1285.
  2. Sirota SB., et al. “Global burden of lower respiratory infections and aetiologies, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023”. Lancet Infectious Diseases (2025).
  3. A Putot., et al. “Comprehensive management of pneumonia in older patients”. European Journal of Internal Medicine 135 (2025): 14-24.
  4. Povoa P., et al. “How to approach a patient hospitalized for pneumonia who is not responding to treatment?” Intensive Care Medicine 5 (2025): 893-903.
  5. Podolsky SH. “The changing fate of pneumonia as a public health concern in 20th-century America and beyond”. American Journal of Public Health 12 (2005): 2144-2154.
  6. Orent W. "A Brief History of Staph". Proto Magazine. Massachusetts General Hospital (2006).
  7. Aminov RI. "A brief history of the antibiotic era: lessons learned and challenges for the future". Frontiers in Microbiology 1 (2010): 134.
  8. Metlay JP., et al. “Diagnosis AND treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American thoracic society and infectious diseases society of America”. American Journal of Respiratory and Critical Care Medicine 7 (2019): e45-e67.
  9. Martin-Loeches I., et al. “ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia”. Intensive Care Medicine 49 (2023): 615-632.
  10. Kyriazopoulou E., et al. “BioFire® FilmArray® pneumonia panel for severe lower respiratory tract infections: subgroup analysis of a randomized clinical trial”. Infectious Diseases and Therapy 3 (2021): 1437-1449.
  11. Pickens CI., et al. “Microbiology of severe community-acquired pneumonia and the role of rapid molecular techniques”. Seminars in Respiratory and Critical Care Medicine2 (2024): 158-168.
  12. Ling L., et al. “Bacterial multiplex polymerase chain reaction tests for the diagnosis and management of pneumonia: ready for prime time?” Thorax 11 (2025): 862-872.
  13. C Heneghan., et al. “Differentiating viral from bacterial pneumonia”. April 8, 2020. The Centre for Evidence-Based Medicine. Evidence Service to support the COVID-19 response. University of Oxford (2020).
  14. Kamat IS., et al. “Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis”. Clinical Infectious Diseases 3 (2020): 538-542.
  15. Lhommet C., et al. “Predicting the microbial cause of community-acquired pneumonia: can physicians or a data-driven method differentiate viral from bacterial pneumonia at patient presentation?” BMC Pulmonary Medicine 20 (2020): 62.
  16. Gadsby NJ and Musher DM. “The microbial etiology of community-acquired pneumonia in adults: from classical bacteriology to host transcriptional signatures”. Clinical Microbiology Reviews 4 (2022): e00015-22.
  17. Alex R Schuurman., et al. “The host response in different aetiologies of community-acquired pneumonia”. The Lancet, Discovery Science 81 (2022): 104082.
  18. Antimicrobial resistance (2021).
  19. WHO Revised global burden of disease 2002 estimates (2004).
  20. Ruuskanen O., et al. “Viral pneumonia”. Lancet 9773 (2011): 1264-1275.
  21. Zhou F., et al. “Disease severity and clinical outcomes of community acquired pneumonia caused by non-influenza respiratory viruses in adults: a multicenter prospective registry study from CAP-China Network”. European Respiratory Journal 2 (2019): 1802406.
  22. Cilloniz C., et al. “Pure viral sepsis secondary to community-acquired pneumonia in adults: risk and prognostic factors”. Journal of Infectious Diseases 7 (2019): 1166-1171.
  23. Palomeque A., et al. “A review of the value of point-of-care testing for community-acquired pneumonia”. Expert Review of Molecular Diagnostics 8 (2024): 729-742.
  24. Sakamoto Y., et al. “In-hospital mortality associated with community-acquired pneumonia due to methicillin-resistant Staphylococcus aureus: a matched-pair cohort study”. BMC Pulmonary Medicine 21 (2021): 345.
  25. Ding H., et al. “Incidence of drug-resistant pathogens in community-acquired pneumonia at a safety net hospital”. Microbiology Spectrum 12 (2024): e00792-24.
  26. Gohil SK., et al. “Initial antibiotic selection strategy and subsequent antibiotic use—insights from the INSPIRE trials”. Journal of the American Medical Association 12 (2025): 1107-1109.
  27. Aubry-Damon H., et al. “Antimicrobial resistance in commensal flora of pig farmers”. Emerging Infectious Diseases 5 (2004): 873-879.
  28. Albrich WC and Harbarth S. “Health-care workers: Source, vector, or victim of MRSA?” Lancet Infectious Diseases 8 (2008): 289-301.
  29. Graveland H., et al. “Methicillin resistant Staphylococcus aureus ST398 in veal calf farming: human MRSA carriage related with animal antimicrobial usage and farm hygiene”. PLoS ONE 5 (2010): e10990.
  30. Long ME., et al. “Pathogenesis of pneumonia and acute lung injury”. Clinical Science (London)10 (2022): 747-769.
  31. Hellou M., et al. “Performance of BIOFIRE FILMARRAY pneumonia panel in suspected pneumonia: insights from a real-world study”. Microbiology Spectrum 7 (2025): e00571-25.
  32. Barnali Kakati., et al. “Comparative performance of biofire pneumonia panel and standard culture-based methods for diagnosing pneumonia in critically ill patients: Impact on antibiotic stewardship”. Indian Journal of Medical Microbiology 49 (2024): 100564.
  33. Paulo Guilherme Oliveira E Silva., et al. “Community-acquired pneumonia: Epidemiology, diagnosis, prognostic severity scales, and new therapeutic options”. Medwave11 (2023): e2719.
  34. C Georgiou., et al. “Effect of antibiotics efficacy in patients with sepsis and septic shock presenting in the emergency department: A literature review”. Journal of Critical Care 81 (2024): 154667.
  35. Regunath H and Oba Y. “Community-acquired pneumonia”. In: StatPearls. Treasure Island (FL): StatPearls Publishing (2025).
  36. Oran DP and Topol EJ. “Prevalence of asymptomatic SARS‐CoV‐2 infection”. Annals of Internal Medicine 173 (2020): 362-367.
  37. Murad M and Martin JC. “Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages”. Nature Reviews Immunology 20 (2020): 355-362.
  38. Zhou B., et al. “COVID‐19 pathogenesis, prognostic factors, and treatment strategy: Urgent recommendations”. Journal of Medical Virology5 (2021): 2694-2704.
  39. Virk Abinash., et al. “Rapid multiplex PCR panel for pneumonia in hospitalised patients with suspected pneumonia in the USA: a single-centre, open-label, pragmatic, randomised controlled trial”. The Lancet Microbe12 (2024): 100928.
  40. Ann R Falsey., et al. “Real-life assessment of biofire film array pneumonia panel in adults hospitalized with respiratory illness”. The Journal of Infectious Diseases1 (2024): 214-222.
  41. Gupta AB., et al. “Antibiotic de-escalation in adults hospitalized for community-onset sepsis”. JAMA Internal Medicine 2 (2025): 192-202.
  42. Verbakel Jan Yvan., et al. “A clinical decision tool including a decision tree, point-of-care testing of CRP, and safety-netting advice to guide antibiotic prescribing in acutely ill children in primary care in Belgium (ARON): a pragmatic, cluster-randomised, controlled trial”. The Lancet10512 (2025): 1599-1610.
  43. Walker PJ., et al. “Can child pneumonia in low-resource settings be treated without antibiotics? A systematic review & meta-analysis”. Journal of Global Health 12 (2022): 10007.
  44. Menéndez R., et al. “Basic host response parameters to classify mortality risk in COVID-19 and community-acquired pneumonia”. Scientific Reports 14 (2024): 12726.
  45. JA Ramirez. “Overview of community-acquired pneumonia in adults”. Section Editor: T. M File. UpToDate, Wolters Kluwer (2024).
  46. Weiss SL., et al “Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children”. Intensive Care Medicine 46 (2020): 10-67.
  47. Boëlle P-Y., et al. “Trajectories of hospitalization in COVID-19 patients: an observational study in France”. Journal of Clinical Medicine 10 (2020): 3148.
  48. Gattinoni L., et al. “COVID-19 pneumonia: pathophysiology and management”. European Respiratory Review 162 (2021): 210138.
  49. Zampieri FG., et al. “Addressing heterogeneous treatment effects in acute care syndromes: principles and practical considerations”. Thorax (2025).
  50. DC Fajgenbaum and CH June. “Cytokine Storm”. New England Journal of Medicine 383 (2020): 2255-2273.
  51. JM Sanchez and HS Kulkarni. “Think locally, act globally: resolving the peripheral immune milieu in bacterial pneumonia”. American Journal of Respiratory and Critical Care Medicine12 (2025): 2242-2244.
  52. Dettlaff-Pokora A and Swierczynski J. “Dysregulation of the renin-angiotensin-aldosterone system (RAA) in patients infected with SARS-CoV-2-possible clinical consequences”. International Journal of Molecular Sciences9 (2021): 4503.
  53. Olivia Vynn. “Cardiology secrets”. Chapter 41. Adair Edition: 2, illustrated Published by Elsevier Health Sciences, 2001 ISBN 1-56053-420-6, 978-1-56053-420-4 (2001): 210.
  54. A Sarma., et al. “Acute respiratory distress syndrome molecular phenotypes have distinct lower respiratory tract transcriptomes”. American Journal of Respiratory and Critical Care Medicine 12 (2025): 2352-2362.
  55. Jain V., et al “Pneumonia Pathology”. In: StatPearls [Internet]. Treasure Island (FL): StatPearls (2023).
  56. I Klepikov. “Myths, legends and real facts about acute lung inflammation”. Cambridge Scholars Publishing. ISBN: 1-0364-0293-2 ISBN13: 978-1-0364-0293-8 (2024): 334.
  57. Schwiegk H. “Der Lungenentlastungsreflex”. Pflügers Archiv 236 (1935): 206-219.
  58. Thillai M., et al. “Functional respiratory imaging identifies redistribution of pulmonary blood flow in patients with COVID-19”. Thorax2 (2021): 182-184.
  59. Dierckx W., et al. “CT-derived measurements of pulmonary blood in small vessels and the need for supplemental oxygen in COVID-19 patients”. Journal of Applied Physiology (1985)6 (2022): 1295-1299.

Igor Klepikov. “Deduction and Induction in Solving the Problem of Acute Pneumonia”. EC Pulmonology and Respiratory Medicine 15.3 (2026): 01-11.