From the Guidelines
The recommended empiric treatment for Community-Acquired Pneumonia (CAP) is a respiratory fluoroquinolone (such as levofloxacin or moxifloxacin) or a combination of a beta-lactam (such as ceftriaxone or ampicillin-sulbactam) plus a macrolide (such as azithromycin), depending on the treatment setting and patient risk factors. For outpatient treatment of previously healthy individuals, a macrolide (such as azithromycin) or doxycycline is recommended as first-line therapy 1. For outpatients with comorbidities or recent antibiotic use, a respiratory fluoroquinolone (levofloxacin 750mg daily or moxifloxacin 400mg daily) or a combination of amoxicillin-clavulanate 875/125mg twice daily plus a macrolide (azithromycin 500mg on day 1, then 250mg daily for 4 days) is appropriate 1. For hospitalized non-ICU patients, a beta-lactam (ceftriaxone 1-2g daily, ampicillin-sulbactam 1.5-3g every 6 hours, or cefotaxime 1-2g every 8 hours) plus a macrolide is recommended 1. For ICU patients, broader coverage with a beta-lactam plus either a respiratory fluoroquinolone or azithromycin is needed 1. Treatment duration is typically 5-7 days for most patients, with clinical improvement guiding therapy length 1. These regimens target the most common CAP pathogens including Streptococcus pneumoniae, Haemophilus influenzae, atypical organisms (Mycoplasma, Chlamydia, Legionella), and respiratory viruses, while considering local resistance patterns and individual risk factors for drug-resistant pathogens 1. Some studies have shown that the use of fluoroquinolones or macrolides can improve outcomes in patients with CAP, particularly in those with severe disease or at risk for drug-resistant pathogens 1. However, the choice of empiric treatment should be guided by local resistance patterns, patient comorbidities, and recent antibiotic use, as well as the severity of illness and the need for hospitalization 1. In general, the treatment of CAP should be individualized based on the specific clinical scenario and the availability of diagnostic testing to guide therapy 1.
From the FDA Drug Label
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 Intravenous therapy should be followed by azithromycin by the oral route at a single, daily dose of 500 mg, administered as two 250 mg tablets to complete a 7 to 10 day course of therapy.
The recommended empiric treatment for Community-Acquired Pneumonia (CAP) is azithromycin 500 mg IV for at least 2 days, followed by azithromycin 500 mg PO to complete a 7 to 10 day course of therapy 2.
From the Research
Empiric Treatment for Community-Acquired Pneumonia (CAP)
The recommended empiric treatment for CAP includes:
- Monotherapy with a respiratory fluoroquinolone 3
- Combination therapy with a beta-lactam and a macrolide for patients admitted to the general medical ward 3
- Combination therapy with a beta-lactam and either a respiratory fluoroquinolone or a macrolide for patients admitted to the intensive care unit (ICU) and who do not have risk factors for methicillin-resistant S. aureus or Pseudomonas 3 Some studies suggest that levofloxacin is at least as effective as amoxicillin/clavulanate plus clarithromycin in clinical and microbiological responses 4, and can be a simple, effective, and safe therapeutic option for patients with CAP that requires hospitalization 5 Key considerations for empiric therapy include:
- Severity of CAP
- Single vs multiple pathogens
- Pharmacokinetic considerations
- Antibiotic resistance 6
- Local resistance patterns must be considered when choosing empiric therapy 3