Purpose: The purpose of this study is to characterize the practices of pulmonary, internal medicine, and critical care physicians toward the management of patients with severe community-acquired pneumonia (CAP). Materials and methods: A cross-sectional international anonymous survey was conducted among a convenience sample of critical care, pulmonary, emergency, and internal medicine physicians from Portugal, Spain, and South America between October and December 2008. The electronic survey evaluated physicians’ attitudes toward diagnosis, risk assessment, and therapeutic interventions for patients with severe CAP. Results: Four hundred sixty-eight physicians responded being 84.6% from 4 countries (Brazil, Portugal, Spain, and Argentina) whom 66.9% had more than 10 years experience. Risk assessment of severe CAP was very heterogeneous being clinical evaluation the most frequent. Although blood cultures were recognized as presenting a poor diagnostic performance, they were performed by 77.1%. In opposition, the presence of urinary pneumococcal and Legionella antigen was asked by less than one-third of physicians. The great majority (95%) prescribes antibiotics according to a guideline being the combination of β-lactam plus macrolide the most frequent choice. Conclusions: Despite the recent advances of knowledge reflected in the present study in the management of severe CAP, several of themare still incompletely translated into clinical practice. Significant variation in practice is observedamong physicians and represents a potential target for future research and educational interventions.