What is the treatment for community-acquired pneumonia?

From the Guidelines

Community-acquired pneumonia (CAP) should be treated with antibiotics that target the most common bacterial causes, including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms like Mycoplasma pneumoniae, with first-line treatment for most healthy adults being amoxicillin 1g three times daily 1.

Treatment Approach

The treatment approach for CAP depends on the severity of the disease and the patient's risk factors. For outpatient settings, oral antibiotics are typically used for 5-7 days.

• First-line treatment for most healthy adults is amoxicillin 1g three times daily.
• For patients with penicillin allergies or in areas with high pneumococcal resistance, alternatives include doxycycline 100mg twice daily or a macrolide such as azithromycin 500mg on day one followed by 250mg daily for 4 more days 1.
• For patients with comorbidities like COPD, diabetes, or recent antibiotic use, consider a respiratory fluoroquinolone (levofloxacin 750mg daily) or combination therapy with amoxicillin-clavulanate plus a macrolide.

Patient Care

Patients should rest, maintain hydration, and use acetaminophen for fever and discomfort. Clinical improvement should begin within 48-72 hours; if symptoms worsen or don't improve, reevaluation is necessary.

• Elderly patients and those with significant comorbidities may require closer monitoring or initial hospitalization depending on their clinical presentation and risk factors.
• The microbial etiology of CAP is changing, particularly with the widespread introduction of the pneumococcal conjugate vaccine, and there is increased recognition of the role of viral pathogens 1.

From the FDA Drug Label

The recommended dose of Azithromycin for Injection for the treatment of adult patients with community-acquired pneumonia due to the indicated organisms is: 500 mg as a single daily dose by the intravenous route for at least two days Intravenous therapy should be followed by azithromycin by the oral route at a single, daily dose of 500 mg, administered as two 250 mg tablets to complete a 7 to 10 day course of therapy.

Community-acquired pneumonia treatment: Azithromycin is recommended for the treatment of community-acquired pneumonia due to certain organisms. The treatment regimen consists of:

• 500 mg intravenous dose daily for at least 2 days
• Followed by 500 mg oral dose daily to complete a 7 to 10 day course of therapy 2 Key considerations:
• The timing of the switch to oral therapy should be done at the discretion of the physician and in accordance with clinical response.
• If anaerobic microorganisms are suspected, an antimicrobial agent with anaerobic activity should be administered in combination with azithromycin.
• Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors 3

From the Research

Community Aquifer Pneumonia Treatment

• Community-acquired pneumonia (CAP) is a common illness with high rates of morbidity and mortality, with nearly 80% of treatment provided in the outpatient setting 4.
• The predominant pathogen associated with bacterial CAP is Streptococcus pneumoniae, and treatment is often empirical, covering both typical and atypical pathogens 4.
• For patients with comorbidities or recent antibiotic therapy, current guidelines recommend combination therapy with a beta-lactam and a macrolide or an antipneumococcal fluoroquinolone alone 4.

Antibiotic Treatment Options

• Fluoroquinolones, such as moxifloxacin, gatifloxacin, and levofloxacin, have been shown to be effective in the treatment of CAP, with clinical success rates of > 90% 4.
• Azithromycin, telithromycin, and fluoroquinolones have been shown to be efficacious, safe, and tolerable in patients with CAP, even in short-course regimens 4.
• Doxycycline has been recommended as a treatment option for non-severe community-acquired pneumonia in adults, with comparable efficacy to macrolides or fluoroquinolones 5.

Treatment Considerations

• The choice of empirical antibiotic therapy should consider disease severity and the likelihood of a bacterial infection or resistant infection, as well as the risk of harm from overuse of antibacterial drugs 6.
• Hospitalized patients without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days 6.
• Systemic corticosteroid administration within 24 hours of development of severe CAP may reduce 28-day mortality 6.

Special Considerations

• Older adults (≥65 years) and those with underlying lung disease, smoking, or immune suppression are at highest risk for CAP and complications of CAP, including sepsis, acute respiratory distress syndrome, and death 6.
• Patients with CAP should be tested for COVID-19 and influenza when these viruses are common in the community, as their diagnosis may affect treatment and infection prevention strategies 6.