What are the antibiotics (Abx) for pneumonia?

From the Guidelines

For community-acquired pneumonia, the recommended first-line antibiotic treatment is a beta-lactam (such as ampicillin-sulbactam, cefotaxime, or ceftriaxone) plus a macrolide (such as azithromycin) or a respiratory fluoroquinolone, as outlined in the 2019 American Thoracic Society and Infectious Diseases Society of America guidelines 1.

Key Considerations

• The choice of antibiotic should be based on the severity of the pneumonia, the patient's risk factors for drug-resistant pathogens, and local antimicrobial resistance patterns.
• For patients with severe pneumonia or those at risk for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa, broader-spectrum antibiotics such as vancomycin, linezolid, or antipseudomonal beta-lactams (e.g., piperacillin-tazobactam, cefepime, or ceftazidime) may be necessary 1.
• Treatment duration should typically be 5-7 days for uncomplicated cases, but may extend to 7-10 days for more severe infections or those caused by certain pathogens such as MRSA or P. aeruginosa 1.

Antibiotic Options

• For outpatient treatment, options include:
  • Amoxicillin-clavulanate 875/125mg twice daily plus azithromycin 500mg on day 1 followed by 250mg daily for 4 more days.
  • Levofloxacin 750mg daily or moxifloxacin 400mg daily.
• For inpatient treatment, options include:
  • Ceftriaxone 1-2g daily plus azithromycin 500mg daily.
  • Piperacillin-tazobactam 4.5g every 6 hours or cefepime 2g every 8 hours, with or without vancomycin or linezolid for MRSA coverage.

Monitoring and Adjustment

• Clinical improvement should occur within 48-72 hours; if not, reassessment is necessary to consider antibiotic resistance or alternative diagnoses.
• Antibiotic therapy should be adjusted or streamlined based on microbiologic data and clinical response to therapy 1.

From the FDA Drug Label

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 Clinical success rates in clinically and microbiologically evaluable patients at the posttherapy visit (primary study endpoint assessed on day 3 to 15 after completing therapy) were 58.1% for levofloxacin and 60. 6% for comparator. Clinical success (cure plus improvement) with levofloxacin at 5 to 7 days posttherapy, the primary efficacy variable in this study, was superior (95%) to the control group (83%). The clinical success rate in patients with atypical pneumonia due to Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila were 96%, 96%, and 70%, respectively.

The antibiotics (Abx) for pneumonia are:

• Levofloxacin: effective for the treatment of community-acquired pneumonia caused by multi-drug resistant Streptococcus pneumoniae (MDRSP) and atypical pneumonia due to Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila.
• Azithromycin: 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.
• Ceftriaxone: used as a comparator in a study of levofloxacin for the treatment of community-acquired pneumonia.
• Cefuroxime axetil: used as a comparator in a study of levofloxacin for the treatment of community-acquired pneumonia. 2 3

From the Research

Antibiotics for Pneumonia

The following antibiotics are used to treat pneumonia:

• Beta-lactams (e.g. ceftriaxone, ampicillin-sulbactam) 4, 5, 6, 7
• Macrolides (e.g. azithromycin, clarithromycin, erythromycin) 4, 5, 6, 7
• Fluoroquinolones (e.g. levofloxacin, moxifloxacin, gatifloxacin) 4, 5, 6, 7
• Combination therapy with a beta-lactam and a macrolide or an antipneumococcal fluoroquinolone alone 4, 7

Specific Treatment Regimens

• Ceftriaxone plus azithromycin, followed by step-down to oral azithromycin 5, 6
• Ceftriaxone combined with either clarithromycin or erythromycin, followed by step-down to either oral clarithromycin or erythromycin 6
• Levofloxacin monotherapy 4, 5, 7
• High-dose, short-course therapy regimens with levofloxacin, azithromycin, or telithromycin 4, 7

Treatment Guidelines

• For community-acquired pneumonia (CAP) requiring hospitalization, guidelines recommend either a beta-lactam and macrolide combination or a fluoroquinolone 4, 7
• For healthcare-associated pneumonia (HCAP), treatment is similar to hospital-acquired pneumonia (HAP) and may be considered with HAP 7
• For early-onset HAP, VAP, and HCAP without the risk of multidrug resistance, ceftriaxone, ampicillin-sulbactam, ertapenem, or one of the fluoroquinolones is recommended 7