The correct assessment of the severity of the disease in patients with community-acquired pneumonia (CAP) and the resulting management of treatment is pivotal for the clinical outcome. In particular, the clinical assessment of the physician is decisive for the location and course of treatment. The application of scoring systems, such as CRB 65, that predict mortality and are easy to calculate, make admission decisions more objective. In the future, monitoring of biomarkers may further help physicians to estimate patient prognosis and facilitate management of treatment. The elderly and notably those with significant comorbidities show the highest mortality with CAP. Given that scoring systems are not reliably predictive in this population, comorbidity should prompt physicians to consider hospitalization. Frequently, CAP is a terminal event in the very elderly and in highly comorbid patients. In this situation management requires the definition of individual therapeutic goals. These individual goals, the wishes of the patient and the resources in the outpatient setting, have an impact on the decision for hospitalization. In the majority of patients in the outpatient setting with hospital-acquired pneumonia (HAP) or pneumonia associated with immunosuppression, hospitalization is mandatory for diagnostic and therapeutic reasons.