What is the treatment for pneumonia in adults?

From the Guidelines

Pneumonia in adults is typically treated with antibiotics, with the specific regimen depending on the severity and setting of the infection, and the most recent guidelines recommend a respiratory fluoroquinolone or a beta-lactam plus a macrolide for hospitalized patients. The treatment of pneumonia in adults depends on several factors, including the severity of the disease, the presence of comorbidities, and the likelihood of drug-resistant pathogens.

• For mild community-acquired pneumonia in otherwise healthy adults, oral antibiotics like amoxicillin (1000mg three times daily for 5-7 days) or doxycycline (100mg twice daily for 5-7 days) are recommended 1.
• For more severe cases requiring hospitalization, combination therapy with a beta-lactam (such as ceftriaxone 1-2g IV daily) plus a macrolide (azithromycin 500mg IV/oral daily) is often used 1.
• Patients with risk factors for drug-resistant pathogens may need broader coverage with respiratory fluoroquinolones like levofloxacin (750mg daily) 1. The choice of antibiotics should target the most likely pathogens while considering local resistance patterns, with therapy narrowed once culture results are available to reduce antibiotic resistance development.
• Supportive care is also essential, including adequate hydration, oxygen supplementation if needed, and fever control with acetaminophen or NSAIDs.
• Treatment duration typically ranges from 5-7 days for uncomplicated cases to 10-14 days for more severe infections.
• Patients should show clinical improvement within 48-72 hours of starting antibiotics, and if symptoms worsen or don't improve, reevaluation is necessary to consider alternative diagnoses or resistant organisms. The most recent study 1 provides the highest quality evidence for the treatment of pneumonia in adults, and its recommendations should be followed to ensure the best possible outcomes.

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 treatment for pneumonia in adults with azithromycin is 500 mg intravenously once daily for at least 2 days, followed by 500 mg orally once daily for 7 to 10 days 2.

• The switch to oral therapy should be done at the discretion of the physician and in accordance with clinical response.
• If anaerobic microorganisms are suspected, an antimicrobial agent with anaerobic activity should be administered in combination with azithromycin.

From the Research

Treatment Options for Pneumonia in Adults

The treatment for pneumonia in adults can vary depending on the severity and type of pneumonia.

• The conventional treatment for community-acquired pneumonia (CAP) involves combination therapy consisting of a β-lactam penicillin or a cephalosporin with a macrolide 3.
• Alternatively, high-dose levofloxacin treatment has been used as single-agent therapy for treating CAP, covering atypical pathogens 3, 4.
• For hospitalized patients with moderate to severe CAP, the combination of a third-generation cephalosporin and a macrolide is at least as efficacious as monotherapy with a fluoroquinolone with enhanced anti-pneumococcal activity 4.
• Primary treatment for community-acquired pneumonia in young adults without comorbidities is erythromycin, while older adults or those with comorbidities should be treated with erythromycin plus trimethoprim-sulfamethoxazole, a second- or third-generation cephalosporin, or a new macrolide 5.
• A network meta-analysis found that nemonoxacin, levofloxacin, and telithromycin were most likely to achieve clinical response, while penicillin and amoxicillin were least likely to achieve clinical response 6.
• Quinolones and macrolides were most effective for clinical response, with amoxicillin-clavulanate plus macrolides and beta-lactams being less effective 6.
• Appropriate initial therapy for patients requiring hospitalization includes a third-generation cephalosporin (such as ceftriaxone or cefotaxime) plus a macrolide or a quinolone 7.

Antibiotic Therapy

• Empiric therapy for moderately or severely ill hospitalized patients usually begins with erythromycin plus a second- or third-generation cephalosporin 5.
• The use of quinolones as monotherapy for pneumonia may promote the emergence of resistant strains, but they are more reliable than the macrolides and doxycycline against pneumococcal strains that exhibit reduced susceptibility to penicillin G 7.
• Levofloxacin, nemonoxacin, azithromycin, and amoxicillin-clavulanate were most likely to be associated with lower mortality 6.
• Quinolones were most likely to be associated with lower mortality, with a p-score of 0.63 6.