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

From the Guidelines

Community-acquired pneumonia (CAP) in adults should be treated with empiric antibiotics for a minimum of 5 days, with extension of therapy guided by validated measures of clinical stability, as recommended by the 2021 American College of Physicians guidelines 1.

Treatment Options

The choice of antibiotic depends on the severity of the disease and the presence of risk factors.

• For outpatient treatment of healthy individuals without risk factors, amoxicillin 1g three times daily for 5 days is recommended, with alternatives including doxycycline 100mg twice daily or azithromycin 500mg on day 1, then 250mg daily for days 2-5.
• For patients with comorbidities or recent antibiotic use, amoxicillin-clavulanate 875/125mg twice daily plus a macrolide, or a respiratory fluoroquinolone like levofloxacin 750mg daily for 5 days is appropriate.
• Hospitalized non-ICU patients should receive a beta-lactam (ampicillin-sulbactam 3g IV every 6 hours or ceftriaxone 1-2g IV daily) plus a macrolide.
• Severely ill patients requiring ICU admission need broader coverage with a beta-lactam plus either a macrolide or fluoroquinolone.

Duration of Treatment

Treatment duration is typically 5 days for mild-moderate cases and 7-10 days for severe cases, extending therapy if the patient remains febrile after 72 hours or has complications.

Supportive Care

Supportive care including adequate hydration, fever control, and oxygen supplementation as needed is essential. Early antibiotic administration improves outcomes by targeting the most common pathogens (Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms) before culture results are available, as supported by the 2003 guidelines for the management of community-acquired pneumonia in immunocompetent adults 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. 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 treatment for community-acquired pneumonia (CAP) in adults is azithromycin. The recommended dose is:

• 500 mg intravenously for at least 2 days, followed by
• 500 mg orally for 7 to 10 days 2 Azithromycin is effective against CAP due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Streptococcus pneumoniae in patients suitable for oral therapy 3

From the Research

Treatment Options for Community-Acquired Pneumonia (CAP) in Adults

• The treatment of CAP is typically empirical, covering both typical and atypical pathogens 4.
• Beta-lactams have been considered standard therapy for CAP, but rising resistance rates are a concern 4.
• For patients with comorbidities or recent antibiotic therapy, guidelines recommend combination therapy with a beta-lactam and a macrolide or an antipneumococcal fluoroquinolone alone 4.
• Fluoroquinolones, such as levofloxacin, gatifloxacin, and moxifloxacin, have been shown to be effective in treating CAP, with clinical success rates of > 90% 4.
• Azithromycin, telithromycin, and fluoroquinolones in short-course regimens have also been shown to be efficacious, safe, and tolerable in patients with CAP 4.

Comparison of Antibiotic Therapies

• A study comparing levofloxacin monotherapy to azithromycin and ceftriaxone combination therapy found that levofloxacin was at least as effective in treating CAP 5.
• Another study found that doxycycline was as efficacious as levofloxacin in treating CAP, with a shorter length of stay and lower antibiotic cost 6.
• The use of levofloxacin, ceftriaxone, imipenem-cilastatin, and azithromycin has been reported in various studies, with levofloxacin being one of the most frequently used antibiotics 7.

Antibiotic Resistance and Treatment Guidelines

• The increasing problem of antimicrobial resistance, particularly macrolide-resistant pneumococcal bacteremia, requires physicians to adopt new approaches to treating CAP 5.
• Guidelines recommend empiric antibiotic therapy that covers both typical and atypical pathogens, with consideration of the patient's comorbidities and recent antibiotic use 4, 8.
• The choice of antibiotic therapy should be based on the patient's specific needs and the local resistance patterns 7.