Pneumonia is an important cause of morbidity and mortality in severe burn patients. Risk factors associated with pneumonia are the severity of the thermal injury and the presence of inhalation injury. Most pneumonias are endogenous, that is, infection of the respiratory tract is preceded by colonization of the digestive tract, oropharynx, and/or gut. Strategies to prevent pneumonia are based on strict proper airway management. Selective digestive decontamination may play an important role in the prophylaxis of pneumonia. Severely ill burn patients have a higher incidence of pneumonia than other generally critically ill patients. Because burn trauma and inhalation injury induce a marked systemic inflammatory response syndrome, the diagnosis of infectious pneumonia in these patients is especially difficult. Nevertheless, the same criteria used in other subsets of critically ill patients should be used in burn patients for the diagnosis of pneumonia. Clinicians should be aware of pharmacokinetic alterations when prescribing systemic antibiotics.