What is the recommended antibiotic for community-acquired pneumonia (CAP)?

From the Guidelines

Community-acquired pneumonia (CAP) treatment should be guided by the severity of the disease and the patient's risk factors, with a focus on covering the most likely pathogens, as recommended by the American Thoracic Society and Infectious Diseases Society of America 1.

Recommended Antibiotics

For CAP, the following antibiotics are recommended:

• For patients without risk factors for MRSA or P. aeruginosa, treatment options include:
  • Azithromycin
  • Doxycycline
  • Amoxicillin-clavulanate
• For patients with risk factors for MRSA, empiric treatment options include:
  • Vancomycin (15 mg/kg every 12 h, adjust based on levels)
  • Linezolid (600 mg every 12 h) 1
• For patients with risk factors for P. aeruginosa, empiric treatment options include:
  • Piperacillin-tazobactam (4.5 g every 6 h)
  • Cefepime (2 g every 8 h)
  • Ceftazidime (2 g every 8 h)
  • Aztreonam (2 g every 8 h)
  • Meropenem (1 g every 8 h)
  • Imipenem (500 mg every 6 h) 1

Important Considerations

It's essential to note that antibiotic treatment should be tailored to the individual patient's needs and guided by local resistance patterns and clinical judgment. Additionally, clinicians should only cover empirically for MRSA or P. aeruginosa if locally validated risk factors are present 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

Piperacillin and Tazobactam for Injection is indicated in adults for the treatment of community-acquired pneumonia (moderate severity only) caused by beta-lactamase producing isolates of Haemophilus influenzae.

Recommended Antibiotic for Community-Acquired Pneumonia (CAP):

• Azithromycin (IV) is recommended for the treatment of adult patients with CAP due to the indicated organisms, with a dose of 500 mg as a single daily dose by the intravenous route for at least two days 2.
• Piperacillin-tazobactam (IV) is recommended for the treatment of adult patients with CAP (moderate severity only) caused by beta-lactamase producing isolates of Haemophilus influenzae, with a dose of 3.375 grams every six hours 3.
• Azithromycin (PO) is also an option for the treatment of CAP, with a dose of 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 4.

From the Research

Recommended Antibiotics for Community-Acquired Pneumonia (CAP)

The recommended antibiotics for CAP vary depending on the severity of the disease and the presence of risk factors for resistant bacteria.

• 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.
• For patients with severe CAP, initial antibiotic treatment should be based on the severity of the disease and the likelihood of a bacterial infection or resistant infection 6.
• The IDSA/ATS guidelines recommend classifying patients with CAP into four risk categories and treating them accordingly:
  • Group 1: patients under 65 years without co-morbidities, oral amoxicillin 1 g TID, 7 days.
  • Group 2: patients over 65 years and/or co-morbidities, oral amoxicillin/clavulanate 500/125 mg TID or 875/125 mg BID, or cefuroxime 500 mg BID, 7 days.
  • Group 3: patients admitted to general wards with criteria of moderate severity, ceftriaxone 1-2 g once a day or cefotaxime 1 g TID, IV, 7-10 days.
  • Group 4: patients with severe CAP that must be interned into ICU, ceftriaxone 2 g once a day or cefotaxime 1 g TID, IV, associated to erythromycin 500 QID, levofloxacin 500-1.000 mg once a day, or moxifloxacin 400 mg/once a day, IV, 10-14 days 7.
• Current management guidelines recommend monotherapy with a respiratory fluoroquinolone or combination therapy with a beta-lactam and a macrolide for patients admitted to the general medical ward, or with a beta-lactam and either a respiratory fluoroquinolone or a macrolide for patients admitted to the intensive care unit (ICU) and who do not have risk factors for methicillin-resistant S. aureus or Pseudomonas 8.
• For severe CAP admitted to the critical care unit, levofloxacin is currently the preferred antibiotic approach as it covers both typical and atypical pathogens 9.

Factors Influencing Antibiotic Selection

The selection of antimicrobial therapy is not dependent on co-morbidities, but rather on the pathogen and the severity of the disease 9.

• Local resistance patterns must be considered when choosing empiric therapy 8.
• The presence of risk factors for resistant bacteria, such as previous antibiotic use or hospitalization, should be taken into account when selecting antibiotics 5.