What are the alternative treatments for pneumonia in patients with an allergy to amoxicillin (amoxicillin)

From the Guidelines

For patients with pneumonia who have an amoxicillin allergy, the most appropriate alternative antibiotic option is a macrolide, such as azithromycin 500 mg on day 1 followed by 250 mg daily for 4 more days, due to its efficacy and safety profile as supported by the Infectious Diseases Society of America/American Thoracic Society consensus guidelines 1.

Alternative Treatment Options

Other alternative options include:

• Respiratory fluoroquinolones, such as levofloxacin 750 mg daily for 5-7 days, which may be suitable for more severe cases or hospitalized patients 1
• Tetracyclines, such as doxycycline 100 mg twice daily for 5-7 days, which can be considered as a cost-effective alternative 1
• Cephalosporins, such as cefuroxime 500 mg twice daily for 7-10 days, may be considered if the amoxicillin allergy is non-anaphylactic 1

Considerations

The choice of alternative antibiotic depends on:

• Local resistance patterns
• Severity of illness
• Patient comorbidities
• Nature of the allergy Patients with true anaphylactic reactions to penicillins should strictly avoid beta-lactams 1.

Treatment Duration and Supportive Care

Treatment duration typically ranges from 5-7 days for uncomplicated cases, with longer courses for severe infections. Supportive care, including adequate hydration, rest, and fever control, remains essential alongside antibiotic therapy 1.

From the FDA Drug Label

Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy The alternative treatments for pneumonia in patients with an allergy to amoxicillin are:

• Azithromycin for community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy 2 Key points to consider:
• Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia) 2

From the Research

Alternative Treatments for Pneumonia

In patients with an allergy to amoxicillin, alternative treatments for pneumonia can be considered. The following options are available:

• Levofloxacin: a fluoroquinolone antibacterial agent with a broad spectrum of activity against Gram-positive and Gram-negative bacteria and atypical respiratory pathogens 3
• Azithromycin plus ceftriaxone: a combination of a macrolide and a third-generation cephalosporin, which may be preferred over fluoroquinolones as first-line therapy for hospitalized patients with moderate to severe community-acquired pneumonia (CAP) 4
• Doxycycline plus β-lactam: a recommended alternative for patients with allergies or contraindications to other treatments, which may be a safe empiric regimen for hospitalized CAP patients with non-severe CAP 5
• Carbapenems and fluoroquinolones: alternative antibiotics that may be used in patients with a documented penicillin and/or cephalosporin allergy 6
• High-dose levofloxacin: a single-agent therapy that has been used to treat CAP, covering atypical pathogens, with a clinical efficacy and safety profile comparable to that of ceftriaxone plus azithromycin therapy 7

Key Considerations

When selecting an alternative treatment for pneumonia in patients with an amoxicillin allergy, the following factors should be considered:

• The severity of the pneumonia
• The presence of any underlying medical conditions
• The potential for drug interactions
• The risk of resistant organisms
• The patient's allergy history and any previous adverse reactions to antibiotics

Treatment Options

The treatment options for pneumonia in patients with an amoxicillin allergy can be summarized as follows:

• Levofloxacin 500mg once daily for 7-14 days 3
• Azithromycin 500mg daily plus ceftriaxone 1g daily 4
• Doxycycline plus β-lactam 5
• Carbapenems and fluoroquinolones 6
• High-dose levofloxacin 750mg once daily 7