International guidelines for the treatment of CAP divide patients firstly into those managed as outpatients. In these patients the European Respiratory Society recommends penicillin, aminopenicillin with or without a b-lactamase inhibitor, macrolide, tetracycline, cephalosporin, fluoroquinolone, or oral streptogramin. However these recommendations were first published in 1998 and with the changing pattern of resistance, new guidelines are being developed. In contrast, the US and Canadian guidelines recommend macrolides, doxycycline and fluoroquinolones as their preferred options. In the Canadian recommendations, additional subgroups of patients are identified, and if the patient has COPD with a recent antibiotic already prescribed, then new therapy with a fluoroquinolone is the treatment of choice.