La Neumonía en la era de la Precisión: Integrando la Evidencia 2025 con la Realidad Epidemiológica Colombiana

Introduction: Community-acquired pneumonia (CAP) is no longer a static clinical entity but rather a dynamic syndrome of systemic dysregulation. The publication of the 2025 American Thoracic Society (ATS) guidelines and the recommendations of the Colombian Association of Infectious Diseases (ACIN) demand a profound update of clinical practice. Development: Through a narrative review of the 2024–2025 literature, this article proposes a paradigm shift from blind empirical treatment to phenotype-driven therapy guided by local ecology. Colombian epidemiology is analyzed, highlighting macrolide resistance in Streptococcus pneumoniae (>30%), which mandates abandonment of monotherapy. Risk stratification is discussed, demonstrating the superiority of the SMART-COP score over CURB-65 in predicting the need for intensive respiratory or vasopressor support. From a therapeutic standpoint, the use of hydrocortisone in severe CAP is validated (CAPE COD trial), and ampicillin/sulbactam is positioned as the cornerstone of local inpatient management, with emphasis on safety protocols to prevent cefepime-associated neurotoxicity. Conclusion: Precision medicine in pneumonia is not a luxury but a safety standard. Adapting global evidence to local microbiology and using advanced predictive scores are life-saving interventions.