From the Guidelines
Community-acquired pneumonia (CAP) treatment should be guided by the severity of the disease and the patient's risk factors, with mild CAP typically managed with oral antibiotics such as azithromycin 500 mg once daily for 5 days, doxycycline 100 mg twice daily for 7-10 days, or amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days 1.
Key Considerations
- Moderate to severe CAP may require hospitalization and treatment with intravenous antibiotics such as ceftriaxone 1-2 grams every 24 hours, cefotaxime 1-2 grams every 8 hours, or levofloxacin 500-750 mg every 24 hours 1.
- In patients with severe CAP or those at risk for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa, additional coverage with vancomycin 1 gram every 12 hours or piperacillin-tazobactam 3.375-4.5 grams every 6-8 hours may be necessary 1.
- Treatment duration typically ranges from 5 to 14 days, depending on the severity of the disease, clinical response, and the presence of complications, with patients monitored for clinical improvement and potential side effects from antibiotics 1.
Antibiotic Selection
- The choice of antibiotic should consider the patient's risk factors, including recent hospitalization, prior respiratory isolation, and the presence of comorbidities such as chronic obstructive pulmonary disease (COPD) or diabetes 1.
- Fluoroquinolones such as levofloxacin or moxifloxacin may be used in patients with severe CAP or those at risk for Pseudomonas aeruginosa, while macrolides such as azithromycin or clarithromycin may be used in patients with mild to moderate CAP 1.
- Beta-lactam antibiotics such as ceftriaxone or cefotaxime may be used in combination with a macrolide or fluoroquinolone in patients with severe CAP or those at risk for MRSA or Pseudomonas aeruginosa 1.
From the FDA Drug Label
1.2 Community-Acquired Pneumonia: 7 to 14 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug-resistant Streptococcus pneumoniae [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae 1.3 Community-Acquired Pneumonia: 5 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (excluding multi-drug-resistant isolates [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae
The treatment for community-acquired pneumonia (CAP) is Levofloxacin tablets, which can be administered for either 7 to 14 days or 5 days, depending on the specific causative pathogens and their susceptibility. The 7 to 14 day treatment regimen is indicated for CAP due to a broader range of pathogens, including multi-drug resistant Streptococcus pneumoniae (MDRSP), while the 5 day treatment regimen is indicated for CAP due to Streptococcus pneumoniae (excluding MDRSP), Haemophilus influenzae, Haemophilus parainfluenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae 2.
From the Research
Treatment Overview
The treatment for community-acquired pneumonia (CAP) depends on the severity of the disease and the likely offending pathogens 3, 4, 5, 6.
Antibiotic Therapy
- Expedient delivery of appropriate antibiotic therapy is crucial for successful treatment 3.
- Empiric therapy regimens are recommended based on the site of care and disease severity 3, 5.
- For hospitalized patients without risk factors for resistant bacteria, β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, is recommended for a minimum of 3 days 5.
- Macrolides play an antimicrobial and anti-inflammatory role in CAP, and their use is still being debated 3, 6.
Patient Risk Factors
- Patients with underlying lung disease, smoking, or immune suppression are at highest risk for CAP and complications 5.
- Older adults (≥65 years) are also at high risk for CAP and complications 5.
- Patients with risk factors for drug-resistant pathogens (DRPs) may require different empiric therapy 7.
Additional Therapeutic Interventions
- Systemic corticosteroid administration within 24 hours of development of severe CAP may reduce 28-day mortality 5.
- Supportive measures, such as monitoring of therapy efficacy and adverse effects, are also important for adequate CAP management 4.