Severe community-acquired pneumonia and hospital-acquired pneumonia are common infectious diseases in Germany. They are associated with high mortality especially in the old and multimorbid patient and are thus a challenge in daily clinical practice. While the CRB65 is a thoroughly validated score for risk stratification in community-acquired pneumonia, there is no comparable score for hospital-acquired pneumonia yet. Early initiation of adequate antibiotic treatment is essential for a positive outcome. Hospital-acquired pneumonia is more often associated with multidrug-resistant bacteria, which should be considered in the choice of initial treatment especially if the patient can be considered a member of a risk group. This article focuses on severe pneumonia and gives an overview of the recent guidelines and discusses newly published results.