From the Guidelines
For community-acquired pneumonia (CAP), the recommended antibiotic regimen should be guided by the most recent and highest quality evidence, which suggests prescribing antibiotics for a minimum of 5 days, with extension of therapy guided by validated measures of clinical stability 1.
Treatment Setting and Patient Risk Factors
The choice of antibiotic should be based on effective treatment of the most commonly reported bacterial pathogens, including Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.
- For outpatient treatment of healthy individuals without risk factors, a macrolide, doxycycline, or a fluoroquinolone with enhanced activity against S. pneumoniae is recommended 1.
- For patients with comorbidities or risk factors for drug-resistant pathogens, a combination of a β-lactam with a macrolide or a respiratory fluoroquinolone is recommended 1.
Hospitalized Patients
- For hospitalized non-ICU patients, a fluoroquinolone alone or an extended-spectrum cephalosporin (cefotaxime or ceftriaxone) plus a macrolide is recommended 1.
- For patients hospitalized in the intensive care unit (ICU), ceftriaxone, cefotaxime, ampicillin-sulbactam, or piperacillin-tazobactam in combination with a fluoroquinolone or macrolide is recommended 1.
Treatment Duration
Treatment duration should typically be 5 days for mild-moderate cases and 7 days for severe cases, with longer courses sometimes needed based on clinical response 1. Reassessment at 48-72 hours is essential to confirm appropriate response or adjust therapy if needed.
- The most recent guidelines support the use of shorter-duration antibiotics in the treatment of CAP, with a minimum of 5 days of antibiotics prescribed 1.
From the FDA Drug Label
In the treatment of pneumonia, azithromycin has only been shown to be safe and effective in the treatment of community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy Azithromycin is indicated for the treatment of community-acquired pneumonia (CAP) due to certain bacteria, including:
- Chlamydia pneumoniae
- Haemophilus influenzae
- Mycoplasma pneumoniae
- Streptococcus pneumoniae in patients who are appropriate for oral therapy 2.
From the Research
Antibiotics for Community-Acquired Pneumonia (CAP)
- The treatment of CAP requires expedient delivery of appropriate antibiotic therapy tailored to both the likely offending pathogens and the severity of disease 3.
- Several antibiotic regimens are recommended for the treatment of CAP, including macrolides, fluoroquinolones, and beta-lactams 3, 4, 5, 6.
- A study comparing the efficacy and tolerability of ceftriaxone plus azithromycin with levofloxacin in hospitalized patients with moderate to severe CAP found that both treatments were well tolerated and had favorable clinical outcomes 4.
- Another study comparing levofloxacin with ceftriaxone and azithromycin for treating mild to moderate CAP found that levofloxacin improved patients' signs and symptoms and reduced hospitalization length, with the same rate of side effects 5.
- The choice of antibiotic regimen may depend on the severity of disease, with some regimens being more effective for certain types of CAP, such as community-acquired methicillin-resistant Staphylococcus aureus and drug-resistant Streptococcus pneumoniae 3, 6.
- A multicenter matched cohort study found that azithromycin was associated with lower mortality and more hospital-free days compared to doxycycline in combination with beta-lactams for hospitalized patients with CAP 7.
Recommended Antibiotic Regimens
- Macrolides, such as azithromycin, are recommended for the treatment of CAP, particularly for patients with mild to moderate disease 3, 4, 7.
- Fluoroquinolones, such as levofloxacin, are also recommended for the treatment of CAP, particularly for patients with moderate to severe disease 4, 5.
- Beta-lactams, such as ceftriaxone, are recommended for the treatment of CAP, particularly for patients with severe disease 3, 4, 7.
- Combination therapy with a macrolide and a beta-lactam may be preferred over monotherapy with a fluoroquinolone for hospitalized patients with CAP to minimize the development of multiresistant nosocomial Gram-negative bacilli 4.