The approach to nonresolving pneumonia in the elderly.

Evaluation of slowly resolving or nonresolving pneumonia in the elderly must be based on clear evidence that the disease is behaving outside of the expected norms. Several weeks may be required for even a "typical" pneumonia to resolve in the elderly with comorbid illness. In the presence of an underlying host impairment, the patient should be observed for several additional weeks unless clinical clues raise the suspicion of an unusual infection or noninfectious process. If there is no further evidence of improvement over the extended period of observation, further evaluation is indicated, looking for an unusual infection (particularly tuberculosis or fungal disease) or a noninfectious diagnosis (particularly neoplasm). In our experience, fiberoptic bronchoscopy and computerized tomography are extremely useful first steps in the evaluation of nonresolving pneumonias after an appropriate period of observation.