What oral antibiotics can be given for pneumonia?

Oral Antibiotics for Pneumonia

For community-acquired pneumonia, the recommended oral antibiotics include amoxicillin, macrolides (azithromycin, clarithromycin), fluoroquinolones (levofloxacin, moxifloxacin), doxycycline, and amoxicillin-clavulanate, with selection based on severity, risk factors, and local resistance patterns. 1

First-Line Options for Non-Severe Community-Acquired Pneumonia

Outpatient Treatment

• Amoxicillin: 500-1000 mg three times daily 1
• Macrolides:
  • Azithromycin: 500 mg on day 1, then 250 mg daily for 4 days 2, 1
  • Clarithromycin: 500 mg twice daily 1
• Doxycycline: 100 mg twice daily 1
• Amoxicillin-clavulanate: 875/125 mg twice daily 1
• Respiratory fluoroquinolones (for patients with penicillin allergy or treatment failure):
  • Levofloxacin: 750 mg daily 1
  • Moxifloxacin: 400 mg daily 1

Treatment Based on Specific Pathogens

Streptococcus pneumoniae

• Preferred: Amoxicillin 1 g three times daily 1
• Alternatives: Ceftriaxone, fluoroquinolones (levofloxacin, moxifloxacin), or doxycycline 1

Atypical Pathogens (Mycoplasma, Chlamydia, Legionella)

• Preferred: Macrolides or doxycycline 1, 3
• For Legionella: Levofloxacin or moxifloxacin (preferred), or azithromycin 1

Haemophilus influenzae

• β-lactamase negative: Amoxicillin 1 g three times daily 1
• β-lactamase positive: Amoxicillin-clavulanate or cefuroxime 1

Duration of Treatment

• Standard duration: 5-7 days for most patients with community-acquired pneumonia 1
• Azithromycin: 3-5 days (due to long half-life) 2, 4, 5
• Severe pneumonia: Up to 10-14 days, especially for Legionella or staphylococcal pneumonia 1

Special Considerations

Aspiration Pneumonia

• Preferred options:
  • Amoxicillin-clavulanate 1
  • Clindamycin 1
  • Moxifloxacin 1

Severe Pneumonia (Requiring Hospitalization)

• Combination therapy is often recommended:
  • Non-antipseudomonal cephalosporin (ceftriaxone, cefotaxime) plus a macrolide 1
  • OR a respiratory fluoroquinolone (levofloxacin, moxifloxacin) 1

Risk Factors for Pseudomonas aeruginosa

• Antipseudomonal coverage should be considered in patients with:
  • Recent hospitalization 1
  • Frequent antibiotic use 1
  • Severe lung disease (FEV1 < 30%) 1
  • Recent steroid use 1

Important Cautions

• Azithromycin should not be used in patients with pneumonia who are inappropriate for oral therapy due to moderate to severe illness or significant risk factors 2
• QT prolongation risk with macrolides and fluoroquinolones, especially in elderly patients or those with cardiac conditions 2
• Clostridium difficile-associated diarrhea is a risk with all antibiotics, particularly in hospitalized patients 2
• Switch from IV to oral therapy should be considered when patients show clinical improvement, can take oral medications, and have stable vital signs 1

Monitoring Response

• Assess clinical response within 48-72 hours (improvement in fever, respiratory symptoms) 1
• Consider changing antibiotics if no improvement after 48-72 hours 1
• Follow-up chest radiograph is not necessary before hospital discharge if clinical improvement is adequate 1

Remember that local resistance patterns should guide empiric therapy choices, and treatment should be adjusted based on culture results when available 1.