Antibiotic guidelines for community-acquired pneumonia (CAP) often recommend broad-spectrum agents for severe pneumonia. While these may be entirely appropriate in terms of their spectrum of activity and efficacy, there is a risk that such recommendations could result in over-prescribing of broad-spectrum agents with consequent 'collateral damage', meaning superinfection by resistant pathogens, or selection of antibiotic resistance. Narrow-spectrum agents are often as effective and result in less collateral damage. National and local antibiotic guidance should promote choices of agents for narrow-spectrum prescribing even for severe CAP where appropriate.