From the Guidelines
For community-acquired pneumonia (CAP), empiric antibiotic therapy should be started promptly based on severity, with the most recent guidelines from 2019 recommending a combination of a beta-lactam and a macrolide for hospitalized patients. The choice of antibiotics depends on the severity of the disease, patient comorbidities, and risk factors for drug-resistant pathogens.
Outpatient Treatment
For outpatient treatment of previously healthy individuals, amoxicillin 1g three times daily for 5 days is recommended as first-line therapy 1. For patients with comorbidities or risk factors for drug-resistant pathogens, a combination of amoxicillin-clavulanate 875/125mg twice daily or a respiratory fluoroquinolone like levofloxacin 750mg daily for 5 days is appropriate.
Inpatient Treatment
For hospitalized non-ICU patients, a combination of a beta-lactam (ceftriaxone 1-2g daily) plus a macrolide (azithromycin 500mg daily) for 5-7 days is recommended 1. Severe CAP requiring ICU admission typically requires broader coverage with ceftriaxone plus either azithromycin or a respiratory fluoroquinolone.
Special Considerations
In cases of penicillin allergy, azithromycin 500mg on day 1 followed by 250mg daily for 4 more days or doxycycline 100mg twice daily for 5 days can be used. Treatment duration should generally be 5 days for mild-moderate cases and 7 days for severe cases, with extension based on clinical response.
Pathogen Coverage
These recommendations target the most common pathogens in CAP including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms like Mycoplasma pneumoniae, while considering local resistance patterns and individual risk factors 1. Some key points to consider when choosing antibiotics for CAP include:
- Local resistance patterns
- Patient comorbidities and risk factors for drug-resistant pathogens
- Severity of disease
- Potential for penicillin allergy or other antibiotic allergies
- Need for broader coverage in severe cases or ICU admissions.
From the FDA Drug Label
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
Azithromycin tablets are indicated for the treatment of community-acquired pneumonia (mild severity)
The recommended antibiotics for community-acquired pneumonia (CAP) are:
- Levofloxacin: for the treatment of CAP due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae
- Azithromycin: for the treatment of CAP (mild severity) 2 3
From the Research
Recommended Antibiotics for Community-Acquired Pneumonia (CAP)
The following antibiotics are recommended for the treatment of CAP:
- Doxycycline 4
- Ofloxacin (Floxin) 4
- Azithromycin (Zithromax) 4, 5, 6
- Levofloxacin 5, 7, 8
- Ceftriaxone 5, 6
Combination Therapies
Combination therapies, such as:
- Ceftriaxone plus azithromycin 5, 6
- Ceftriaxone plus clarithromycin or erythromycin 6 are also effective in treating CAP.
Monotherapy
Monotherapy with:
- Levofloxacin 7
- Doxycycline 8 can be used to treat CAP, depending on the severity of the disease and the causative pathogen.
Considerations
When choosing an antibiotic, considerations should be given to:
- The severity of the disease
- The causative pathogen
- The potential for drug resistance
- The cost of treatment 8