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

From the Guidelines

Community acquired pneumonia (CAP) treatment should be guided by the most recent and highest quality evidence, which recommends empiric antibiotic therapy based on severity, with a focus on reducing morbidity, mortality, and improving quality of life. For outpatient treatment of mild to moderate CAP, amoxicillin 1g three times daily for 5 days is a reasonable option, as suggested by 1. However, considering the more recent guidelines from 1, alternatives such as doxycycline 100mg twice daily or azithromycin 500mg on day 1 followed by 250mg daily for 4 more days may be preferred, especially when atypical pathogens are suspected.

For patients with comorbidities or recent antibiotic use, amoxicillin-clavulanate 875/125mg twice daily or a respiratory fluoroquinolone like levofloxacin 750mg daily for 5 days may be more appropriate, as recommended by 1. Severe CAP requiring hospitalization typically needs combination therapy with a beta-lactam (ceftriaxone 1-2g daily or ampicillin-sulbactam 3g every 6 hours) plus a macrolide or respiratory fluoroquinolone, as outlined in 1.

Some key points to consider in CAP treatment include:

• The choice of antibiotics should target the most common pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms like Mycoplasma pneumoniae.
• Treatment duration is generally 5 days for uncomplicated cases, but should be extended if the patient remains febrile or clinically unstable after 5 days.
• Supportive care, including adequate hydration, fever control, and oxygen supplementation as needed, is essential.
• Clinical improvement should occur within 48-72 hours; if not, reassessment for complications or resistant organisms is warranted.

Given the potential for resistant organisms, especially in patients with recent hospitalization or antibiotic use, it is crucial to follow the most recent guidelines, such as those from 1, which provide updated recommendations for empiric antibiotic therapy based on severity and risk factors for drug resistance.

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

Levofloxacin is indicated for the treatment of community-acquired pneumonia caused by various bacteria, including methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, and others.

• The recommended treatment regimen is 7 to 14 days.
• Clinical success rates in patients with community-acquired pneumonia were high, with a success rate of 93% in one study 2.
• Levofloxacin was effective against multi-drug resistant Streptococcus pneumoniae (MDRSP) isolates, with a clinical and bacteriologic success rate of 95% 2.

From the Research

Community Acquired Pneumonia Treatment

• Community-acquired pneumonia is a common infection that requires appropriate initial antibiotic therapy, taking into account recent developments in epidemiology, clinical manifestations, and antibiotic resistance 3.
• The primary treatment for community-acquired pneumonia in young adults without comorbidities is erythromycin, while older adults or those with comorbidities should be treated with a combination of antibiotics such as erythromycin plus trimethoprim-sulfamethoxazole, a second- or third-generation cephalosporin, or a new macrolide 3.
• For moderately or severely ill hospitalized patients, empiric therapy usually begins with erythromycin plus a second- or third-generation cephalosporin 3.
• New antibiotics have been launched with direct agent-specific properties that can help avoid the overuse of broad-spectrum antibiotics when treating patients with severe community-acquired pneumonia 4.
• The choice of antibiotic therapy for community-acquired pneumonia should consider the severity of the disease, the presence of comorbidities, and the likelihood of antibiotic resistance 4, 5.
• Azithromycin has been shown to be associated with lower mortality and more hospital-free days compared to doxycycline in combination with beta-lactams for hospitalized patients with community-acquired pneumonia 6.
• Guidelines for the management of community-acquired pneumonia recommend a wide range of issues surrounding the delivery of care, including advice on admission to the hospital or ICU, antibiotic selection, and diagnostic tests 7.
• The treatment of community-acquired pneumonia in immunocompromised adults requires a consensus statement regarding initial strategies, including the definition of the population, site of care, likely pathogens, and empirical therapy for specific pathogens 5.