What are the recommended medications and their dosages for treating pneumonia?

From the Guidelines

For pneumonia, I would prescribe the following medications and dosages:

• For mild to moderate community-acquired pneumonia (CAP):
  • Azithromycin 500mg orally once daily for 5 days 1
  • or Doxycycline 100mg orally twice daily for 7-10 days 1
  • or Amoxicillin-clavulanate 875mg/125mg orally twice daily for 7-10 days 1
• For severe CAP:
  • Ceftriaxone 1-2g intravenously every 12-24 hours for 7-10 days 1
  • or Cefepime 1-2g intravenously every 8-12 hours for 7-10 days 1
  • plus Azithromycin 500mg intravenously once daily for 5 days 1
• For hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP):
  • Piperacillin-tazobactam 4.5g intravenously every 6 hours for 7-10 days 1
  • or Imipenem 500mg intravenously every 6 hours for 7-10 days 1
  • or Meropenem 1g intravenously every 8 hours for 7-10 days 1
  • plus Vancomycin 15mg/kg intravenously every 12 hours for 7-10 days, with goal to target 15-20 mg/mL trough level 1

Important Considerations

• The choice of antibiotic and duration of treatment may vary depending on the patient's underlying health conditions, severity of illness, and local antibiotic resistance patterns 1
• For patients with severe penicillin allergy, aztreonam may be used as an alternative to β-lactam-based antibiotics 1
• For patients with risk factors for MRSA, vancomycin or linezolid should be added to the treatment regimen 1

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Adult Patients with Indications Other than Nosocomial Pneumonia: The usual daily dosage of piperacillin and tazobactam for injection for adults is 3.375 grams every six hours totaling 13.5 grams (12.0 grams piperacillin and 1.5 grams tazobactam). Adult Patients with Nosocomial Pneumonia: Initial presumptive treatment of patients with nosocomial pneumonia should start with piperacillin and tazobactam for injection at a dosage of 4.5 grams every six hours plus an aminoglycoside, totaling 18.0 grams (16.0 grams piperacillin and 2.0 grams tazobactam). Community-acquired pneumonia (mild severity) 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 Community-Acquired Pneumonia The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with community-acquired pneumonia is 10 mg/kg as a single dose on the first day followed by 5 mg/kg on Days 2 through 5.

The recommended medications and their dosages for treating pneumonia are:

• Piperacillin-tazobactam (IV):
  • For adults with nosocomial pneumonia: 4.5 grams every six hours plus an aminoglycoside, totaling 18.0 grams (16.0 grams piperacillin and 2.0 grams tazobactam) 2
  • For pediatric patients with nosocomial pneumonia: 90 mg/kg (80 mg piperacillin and 10 mg tazobactam) every 6 hours for patients 2 months to 9 months, and 112.5 mg/kg (100 mg piperacillin and 12.5 mg tazobactam) every 6 hours for patients older than 9 months 2
• Azithromycin (PO):
  • For adults with community-acquired pneumonia (mild severity): 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 3
  • For pediatric patients with community-acquired pneumonia: 10 mg/kg as a single dose on the first day followed by 5 mg/kg on Days 2 through 5 3

From the Research

Recommended Medications for Treating Pneumonia

The following medications have been studied for the treatment of community-acquired pneumonia:

• Azithromycin:
  • 1g once daily for 3 days 4
  • 500mg once daily for 3 days 5
  • 2.0g single dose 6
• Amoxicillin-clavulanate:
  • 875/125mg twice daily for 7 days 4
• Clarithromycin:
  • 250mg twice daily for 10 days 5
  • 500mg twice daily for 10 days 7
  • 1.0g/d for 7 days (extended release) 6
• Telithromycin:
  • 800mg once daily for 5 or 7 days 7

Dosage and Treatment Duration

Studies have shown that shorter treatment durations can be effective for community-acquired pneumonia:

• 3-day treatment with azithromycin was found to be effective in several studies 4, 5
• 5-7 day treatment duration is recommended for adults with community-acquired pneumonia 8
• A single 2.0g dose of azithromycin microspheres was found to be as effective as a 7-day course of extended-release clarithromycin 6
• Telithromycin 800mg once daily for 5 or 7 days was found to be as effective as clarithromycin 500mg twice daily for 10 days 7