What is the treatment for Community-Acquired Pneumonia (CAP)?

From the Guidelines

For community-acquired pneumonia (CAP) treatment, the recommended first-line therapy is a respiratory fluoroquinolone alone or an advanced macrolide plus a b-lactam, depending on the patient's variables and recent antibiotic therapy. When considering treatment options for CAP, several factors must be taken into account, including the severity of the disease, the presence of comorbidities, and recent antibiotic use [ 1 ]. The treatment guidelines suggest the following options:

• For outpatients who are previously healthy and have not had recent antibiotic therapy, a macrolide or doxycycline is preferred [ 1 ].
• For outpatients with comorbidities and no recent antibiotic therapy, an advanced macrolide or a respiratory fluoroquinolone is recommended [ 1 ].
• For inpatients, a respiratory fluoroquinolone alone or an advanced macrolide plus a b-lactam is suggested [ 1 ]. Some key points to consider when selecting a treatment regimen include:
• The patient's recent antibiotic use, as this can impact the effectiveness of certain antibiotics [ 1 ].
• The presence of comorbidities, such as COPD or diabetes, which can increase the risk of complications [ 1 ].
• The severity of the disease, as this can impact the need for hospitalization and the intensity of treatment [ 1 ]. It's also important to note that the treatment regimen may need to be adjusted based on the patient's clinical response after 48-72 hours [ 1 ]. Additionally, ensuring adequate hydration and rest, and using antipyretics for fever and analgesics for chest pain if needed, are also crucial in managing CAP [ 1 ]. The selected treatment regimen should cover the most common bacterial causes of CAP, including Streptococcus pneumoniae, Haemophilus influenzae, and atypical pathogens like Mycoplasma pneumoniae [ 1 ]. Macrolides like azithromycin have additional anti-inflammatory effects that may contribute to faster clinical improvement [ 1 ]. Overall, the treatment of CAP requires careful consideration of several factors, and the selected regimen should be based on the most recent and highest-quality evidence available [ 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) with levofloxacin tablets is a 7 to 14 day treatment regimen for certain susceptible microorganisms, or a 5 day treatment regimen for other specific susceptible microorganisms 2.

• The 7 to 14 day treatment regimen is indicated for CAP 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
• Mycoplasma pneumoniae

• The 5 day treatment regimen is indicated for CAP due to:

• Streptococcus pneumoniae (excluding multi-drug-resistant isolates [MDRSP])
• Haemophilus influenzae
• Haemophilus parainfluenzae
• Mycoplasma pneumoniae
• Chlamydophila pneumoniae

From the Research

Treatment Options for Community-Acquired Pneumonia (CAP)

• The treatment for CAP can involve various antibiotic regimens, including fluoroquinolones, doxycycline, and macrolides 3, 4, 5.
• A study comparing doxycycline and levofloxacin found that doxycycline is an effective and economical alternative therapy for levofloxacin in the empirical treatment of CAP in general medical wards 3.
• Gemifloxacin once daily for 5 days has been shown to be non-inferior to 7 days in the treatment of mild-moderate CAP 4.
• Levofloxacin is a fluoroquinolone that has a broad spectrum of activity against several causative bacterial pathogens of CAP, and can be used as a monotherapy or in combination with other antibiotics 5.

Duration of Antibiotic Treatment

• The duration of therapy for CAP remains undefined, but short-course antibiotic treatment (≤6 days) has been shown to be as effective as and potentially superior to longer-course treatment in terms of mortality and serious adverse events 6.
• A systematic review and meta-analysis found that short-course treatment was associated with fewer serious adverse events and lower mortality than long-course treatment 6.

Safety of Antibiotic Regimens

• A study comparing the safety of different antibiotic regimens for the treatment of outpatient CAP found that broad-spectrum antibiotics were associated with increased risk of adverse drug events (ADEs) among otherwise healthy adults 7.
• Narrow-spectrum antibiotic regimens, such as macrolides and doxycycline, were found to confer similar risk of ADEs 7.
• The study highlights the need for antimicrobial stewardship to promote judicious use of broad-spectrum antibiotics and decrease antibiotic-related ADEs 7.