From the Guidelines
For lobar pneumonia, the recommended first-line antibiotic treatment is typically a combination of a beta-lactam antibiotic and a macrolide, such as ceftriaxone 1-2 grams intravenously once daily plus azithromycin 500 mg intravenously once daily for 5-7 days, as recommended by the Infectious Diseases Society of America and the American Thoracic Society 1. The choice of antibiotics is guided by the need to cover Streptococcus pneumoniae, the most common cause of lobar pneumonia, as well as atypical pathogens like Mycoplasma pneumoniae and Legionella pneumophila.
- The beta-lactam (ceftriaxone) targets the cell wall of S. pneumoniae,
- while the macrolide (azithromycin) provides additional coverage and has anti-inflammatory properties. In cases of penicillin allergy, a respiratory fluoroquinolone such as levofloxacin 750 mg orally or intravenously once daily for 5 days can be used as monotherapy 1. For patients with risk factors for Pseudomonas aeruginosa, an antipseudomonal beta-lactam like piperacillin-tazobactam may be necessary 1. It's essential to note that antibiotic choice should be guided by local resistance patterns and adjusted based on culture results when available, as recommended by the Infectious Diseases Society of America and the American Thoracic Society 1. Supportive care, including oxygen therapy and hydration, is also crucial in managing pneumonia. The most recent guidelines from 2016 recommend that the choice of antibiotics should be based on the severity of the disease, the risk of mortality, and the likelihood of MRSA and Pseudomonas aeruginosa 1. In severe cases, the use of vancomycin or linezolid may be necessary to cover MRSA, and the use of an antipseudomonal beta-lactam may be necessary to cover Pseudomonas aeruginosa 1. Overall, the choice of antibiotics for lobar pneumonia should be guided by the most recent guidelines and should take into account the severity of the disease, the risk of mortality, and the likelihood of resistant organisms.
From the FDA Drug Label
The clinical success rates by pathogen across four CAP studies are presented in Table 13 Table 13: Clinical Success Rates By Pathogen (Pooled CAP Studies) Pathogen Moxifloxacin Hydrochloride Streptococcus pneumoniae 80/85 (94%) Staphylococcus aureus 17/20 (85%) Klebsiella pneumoniae 11/12 (92%) Haemophilus influenzae 56/61 (92%) Chlamydophila pneumoniae 119/128 (93%) Mycoplasma pneumoniae 73/76 (96%) Moraxella catarrhalis 11/12 (92%)
The antibiotics used to treat lobar pneumonia include:
- Moxifloxacin
- Levofloxacin
- Amoxicillin/Clavulanate
- Clarithromycin These antibiotics are effective against various pathogens, including Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Haemophilus influenzae, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Moraxella catarrhalis 2 3 4
From the Research
Antibiotics Used to Treat Lobar Pneumonia
- Levofloxacin is a fluoroquinolone antibacterial agent with a broad spectrum of activity against Gram-positive and Gram-negative bacteria and atypical respiratory pathogens, including Streptococcus pneumoniae 5, 6, 7, 8, 9.
- It is active against both penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae 5, 6.
- Levofloxacin has been shown to be effective in the treatment of community-acquired pneumonia (CAP), including lobar pneumonia, with clinical success rates of > 90% 7, 8, 9.
- Other antibiotics that may be used to treat lobar pneumonia include azithromycin, ceftriaxone, and amoxicillin/clavulanic acid 6, 7, 8.
- The choice of antibiotic depends on the severity of the infection, the presence of comorbidities, and the likelihood of antibiotic resistance 7, 8, 9.
Treatment Regimens
- Levofloxacin can be used as a monotherapy in patients with CAP, with a recommended dose of 500 mg once daily for 10 days 5, 6, 9.
- A high-dose (750 mg), short-course (5 days) of once-daily levofloxacin has also been approved for use in the USA in the treatment of CAP 9.
- Combination therapy with anti-pseudomonal beta-lactam (or aminoglycoside) should be considered if Pseudomonas aeruginosa is the causative pathogen of the respiratory infection 9.