From the Guidelines
For community-acquired pneumonia (CAP), the recommended antibiotic regimen depends on the treatment setting and patient risk factors, with a focus on reducing morbidity, mortality, and improving quality of life.
Key Considerations
- The most recent and highest quality study, 1, provides the basis for the recommended antibiotic regimens.
- The treatment setting, whether outpatient or inpatient, and patient risk factors, such as comorbidities or recent antibiotic use, guide the selection of antibiotics.
- The goal is to cover the most common CAP pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms like Mycoplasma pneumoniae.
Outpatient Treatment
- For healthy individuals without risk factors, a macrolide (azithromycin, clarithromycin, or erythromycin) or doxycycline is recommended 1.
- For patients with comorbidities or risk factors for drug-resistant pathogens, a combination of amoxicillin-clavulanate 875/125mg twice daily plus azithromycin 500mg on day 1 followed by 250mg daily for 4 more days is recommended 1.
Inpatient Treatment
- For hospitalized non-ICU patients, ampicillin-sulbactam 3g IV every 6 hours or ceftriaxone 1-2g IV daily plus azithromycin 500mg IV/PO daily for 5-7 days is appropriate 1.
- For ICU patients, broader coverage with ceftriaxone plus either azithromycin or a respiratory fluoroquinolone like levofloxacin 750mg daily is recommended 1.
Treatment Duration
- Treatment duration should generally be 5 days for uncomplicated cases, extending to 7-10 days for more severe infections 1.
- Clinical improvement should be evident within 48-72 hours; if not, reevaluation for complications or resistant organisms is warranted 1.
From the FDA Drug Label
1.2 Community-Acquired Pneumonia: 7 to 14 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug-resistant Streptococcus pneumoniae [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae
DOSAGE & ADMINISTRATION SECTION Adults Infection *Recommended Dose/Duration of Therapy *DUE TO THE INDICATED ORGANISMS (See INDICATIONS AND USAGE.) Community-acquired pneumonia (mild severity) 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5
The recommended antibiotics for Community-Acquired Pneumonia (CAP) are:
- Levofloxacin: 500 mg once daily orally or intravenously for 7 to 14 days
- Azithromycin: 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 2, 3 Key pathogens that can be treated with these antibiotics include:
- Methicillin-susceptible Staphylococcus aureus
- Streptococcus pneumoniae (including multi-drug-resistant Streptococcus pneumoniae [MDRSP])
- Haemophilus influenzae
- Haemophilus parainfluenzae
- Klebsiella pneumoniae
- Moraxella catarrhalis
- Chlamydophila pneumoniae
- Legionella pneumophila
- Mycoplasma pneumoniae
From the Research
Recommended Antibiotics for Community-Acquired Pneumonia (CAP)
The following antibiotics are recommended for the treatment of CAP:
- Beta-lactams, such as amoxicillin/clavulanate 4
- Macrolides, such as azithromycin and clarithromycin 4, 5
- Fluoroquinolones, such as levofloxacin, moxifloxacin, and gatifloxacin 4, 5, 6
- Combination therapy with a beta-lactam and a macrolide, or an antipneumococcal fluoroquinolone alone 4, 7
Specific Recommendations
- For patients with comorbidities or recent antibiotic therapy, combination therapy with a beta-lactam and a macrolide or an antipneumococcal fluoroquinolone alone is recommended 4
- For hospitalized patients with mild-to-moderate CAP, respiratory fluoroquinolone monotherapy or beta-lactam plus macrolide combination therapy are recommended 6, 7
- For patients with severe CAP, combination therapy with a beta-lactam and a macrolide or a fluoroquinolone is recommended 7
Efficacy of Antibiotics
- Clinical trials have shown that fluoroquinolones, such as levofloxacin and moxifloxacin, have high clinical success rates (> 90%) in the treatment of CAP due to S pneumoniae 4, 6
- Respiratory fluoroquinolone monotherapy has been shown to be as efficacious as beta-lactam-macrolide combination therapy in the treatment of CAP patients 5, 6
- The use of azithromycin, telithromycin, and fluoroquinolones in short-course regimens has been shown to be efficacious, safe, and tolerable in patients with CAP 4