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

From the Guidelines

The recommended treatment for community-acquired pneumonia (CAP) depends on the setting and patient factors, with the most recent guidelines from 2019 1 suggesting that outpatient treatment of previously healthy individuals should start with amoxicillin 1g three times daily for 5-7 days or a macrolide, while patients with comorbidities or recent antibiotic use should receive a respiratory fluoroquinolone or a combination of amoxicillin-clavulanate plus a macrolide. For hospitalized non-ICU patients, a beta-lactam plus a macrolide is standard, according to the 2019 guidelines 1. ICU patients typically require broader coverage with a beta-lactam plus either a respiratory fluoroquinolone or azithromycin, as suggested by the 2019 guidelines 1. Treatment duration is generally 5-7 days for most patients, with clinical improvement guiding the decision to stop therapy, and supportive care including oxygen supplementation, hydration, and antipyretics is also essential, as recommended by the 2019 guidelines 1. These regimens target the most common CAP pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms like Mycoplasma pneumoniae, while considering local resistance patterns and individual risk factors for drug-resistant pathogens, as outlined in the 2019 guidelines 1. Some key points to consider in the treatment of CAP include:

• The importance of selecting an antibiotic regimen that covers the most likely pathogens, as suggested by the 2003 guidelines 1.
• The need to consider local resistance patterns and individual risk factors for drug-resistant pathogens, as recommended by the 2000 guidelines 1.
• The use of supportive care, including oxygen supplementation, hydration, and antipyretics, to help manage symptoms and improve outcomes, as suggested by the 2011 guidelines 1 and 1. However, the 2019 guidelines 1 are the most recent and highest quality study, and their recommendations should be prioritized. The 2019 guidelines 1 provide a comprehensive approach to the diagnosis and treatment of CAP, and their recommendations should be followed in clinical practice. Overall, the treatment of CAP requires a thoughtful and individualized approach, taking into account the patient's specific needs and circumstances, as well as the latest evidence and guidelines, with the 2019 guidelines 1 being the most relevant and up-to-date.

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 The recommended dose of azithromycin for adults with community-acquired pneumonia is 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 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

The recommended treatment for community-acquired pneumonia (CAP) is azithromycin.

• The oral dose is 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5.
• The intravenous dose is 500 mg as a single daily dose for at least two days, followed by oral therapy to complete a 7 to 10 day course of therapy 2, 2, 3. Key points:
• Azithromycin is effective against CAP due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Streptococcus pneumoniae.
• Patients with moderate to severe illness or risk factors should not be treated with oral azithromycin.

From the Research

Treatment for Community-Acquired Pneumonia (CAP)

The treatment for CAP depends on the severity of the disease and the likely offending pathogens.

• Expedient delivery of appropriate antibiotic therapy is crucial for successful treatment 4.
• The choice of antibiotic therapy should be tailored to the severity of disease and the likely offending pathogens 4, 5.

Antibiotic Therapy Regimens

• For outpatient treatment, beta-lactams have historically been considered standard therapy, but rising resistance rates are a concern 5.
• Combination therapy with a beta-lactam and a macrolide or an antipneumococcal fluoroquinolone alone is recommended for patients with comorbidities or recent antibiotic therapy 5.
• Fluoroquinolones, such as moxifloxacin, gatifloxacin, and levofloxacin, have been shown to be effective in the treatment of CAP due to S pneumoniae 5.
• Macrolides, such as azithromycin, and fluoroquinolones have been shown to be efficacious, safe, and tolerable in patients with CAP 5.

Duration of Therapy and Transition to Oral Therapy

• The duration of therapy and the transition from intravenous antibiotics to oral therapy should be guided by evidence-based practices 4.
• High-dose, short-course therapies may represent a significant advance in the management of CAP 5.

Antibiotic Resistance

• Antibiotic resistance is a concern in the treatment of CAP, particularly with regards to Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, and Acinetobacter baumannii 6.
• The use of broad-spectrum antibiotics, such as respiratory fluoroquinolones and third-generation cephalosporins, should be guided by local resistance patterns and patient factors 6, 7.

Alternative Treatment Options

• Doxycycline has been shown to be a viable treatment option for mild-to-moderate CAP in adults, with efficacy comparable to macrolides or fluoroquinolones 8.
• However, the quality of evidence for doxycycline is low, and large-scale clinical trials are needed to confirm its efficacy 8.