From the Guidelines
For hospital-acquired pneumonia, the recommended initial empiric antibiotic therapy includes piperacillin-tazobactam 4.5 g IV q6h, cefepime 2 g IV q8h, levofloxacin 750 mg IV daily, imipenem 500 mg IV q6h, or meropenem 1 g IV q8h, depending on the risk of mortality and factors increasing the likelihood of MRSA. The choice of antibiotic should be guided by the patient's risk factors, including the likelihood of MRSA and the severity of illness 1.
Key Considerations
- For patients not at high risk of mortality and without factors increasing the likelihood of MRSA, monotherapy with one of the recommended antibiotics is sufficient.
- For patients not at high risk of mortality but with factors increasing the likelihood of MRSA, the recommended antibiotics include piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem, with the addition of vancomycin or linezolid for MRSA coverage.
- For patients at high risk of mortality or with recent intravenous antibiotic use, combination therapy with two of the recommended antibiotics, avoiding two β-lactams, is recommended, along with vancomycin or linezolid for MRSA coverage.
Antibiotic Options
- Piperacillin-tazobactam 4.5 g IV q6h
- Cefepime 2 g IV q8h
- Levofloxacin 750 mg IV daily
- Imipenem 500 mg IV q6h
- Meropenem 1 g IV q8h
- Vancomycin 15 mg/kg IV q8-12h (with goal to target 15-20 mg/mL trough level)
- Linezolid 600 mg IV q12h It is essential to note that the choice of antibiotic should be tailored to the individual patient's needs and adjusted based on culture results and clinical response to therapy 1. Additionally, local resistance patterns should be considered when selecting empiric antibiotic therapy 1.
From the FDA Drug Label
Treatment of pneumonia 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
- Recommended antibiotic: Azithromycin is recommended for the treatment of community-acquired pneumonia due to specific bacteria, including:
- Chlamydia pneumoniae
- Haemophilus influenzae
- Mycoplasma pneumoniae
- Streptococcus pneumoniae
- Important consideration: Azithromycin should only be used in patients who are appropriate for oral therapy, and not in those with moderate to severe illness or certain risk factors, such as cystic fibrosis, nosocomially acquired infections, or significant underlying health problems 2
From the Research
Recommended Antibiotics for Treating Pneumonia
The following antibiotics are recommended for treating pneumonia:
- A combination of a third-generation cephalosporin (such as ceftriaxone) and a macrolide (such as azithromycin) 3, 4, 5
- A fluoroquinolone (such as levofloxacin) 3, 4, 6
- A beta-lactam (such as ceftriaxone) plus a macrolide (such as azithromycin or clarithromycin) 4, 5
- An antipneumococcal fluoroquinolone alone 6
Considerations for Antibiotic Selection
When selecting an antibiotic for pneumonia treatment, consider the following:
- The severity of the pneumonia 3, 4, 5
- The presence of comorbidities or recent antibiotic therapy 6
- The potential for resistance to certain antibiotics 4, 6
- The need for broad-spectrum or narrow-spectrum antibiotic coverage 7
Clinical Outcomes and Bacteriological Eradication
Studies have shown that the combination of a third-generation cephalosporin and a macrolide, as well as fluoroquinolone monotherapy, can achieve high clinical success rates and bacteriological eradication rates in patients with pneumonia 3, 6, 5. However, the choice of antibiotic should be individualized based on patient-specific factors and local resistance patterns.