From the Guidelines
For a patient transitioning from IV ceftriaxone and azithromycin to oral antibiotics for pneumonia, amoxicillin-clavulanate (875/125 mg twice daily) is a recommended choice, as per the American Thoracic Society and Infectious Diseases Society of America guidelines 1. This recommendation is based on the patient's likely transition from hospital to outpatient setting, where oral antibiotics are preferred for their ease of administration and reduced risk of complications.
- The combination of amoxicillin-clavulanate provides broad-spectrum coverage against common pneumonia pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms.
- If the patient has comorbidities such as chronic heart, lung, liver, or renal disease, the guidelines recommend combination therapy with amoxicillin-clavulanate and a macrolide, such as azithromycin 1.
- Alternatively, for patients with penicillin allergy, doxycycline (100 mg twice daily) can be used as a substitute for amoxicillin-clavulanate, or a respiratory fluoroquinolone like levofloxacin (750 mg daily) can be used as monotherapy 1.
- The total antibiotic duration for community-acquired pneumonia is typically 5-7 days, with clinical improvement expected within 48-72 hours, as per the guidelines 1.
- Patients should continue oral therapy until they've been afebrile for 48-72 hours and have shown clinical improvement in symptoms.
- It is essential to ensure the patient is clinically stable before transitioning to oral therapy, with normal vital signs, ability to take oral medications, and no evidence of sepsis.
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 FDA drug label does not answer the question.
From the Research
Oral Antibiotic Options
When transitioning a patient from azithromycin and ceftriaxone to oral antibiotics for pneumonia, several options can be considered:
- Azithromycin: This macrolide antibiotic can be continued orally, as it has been shown to be effective in treating community-acquired pneumonia (CAP) 2, 3.
- Levofloxacin: This fluoroquinolone antibiotic has been demonstrated to be as effective as the combination of ceftriaxone and azithromycin in treating CAP 2, 4.
- Cefuroxime axetil: This cephalosporin antibiotic can be added to azithromycin if a macrolide-resistant pneumococcal isolate is documented 2.
- Amoxicillin/clavulanic acid: This combination antibiotic has been shown to be effective in eradicating Streptococcus pneumoniae and Haemophilus influenzae in children with acute otitis media 5.
Bacteriological Eradication Rates
The bacteriological eradication rates for different oral antibiotics are:
- Azithromycin: 71.0% against Streptococcus pneumoniae, 70.2% against Haemophilus influenzae 6.
- Levofloxacin: >99% against Streptococcus pneumoniae, 99.8% against Haemophilus influenzae 6.
- Cefuroxime axetil: 72.6% against Streptococcus pneumoniae, 82.8% against Haemophilus influenzae 6.
- Amoxicillin/clavulanic acid: 91.6% against Streptococcus pneumoniae, 98.3% against Haemophilus influenzae 6.
Clinical Outcomes
The clinical outcomes for patients treated with different oral antibiotics are:
- Azithromycin: Favorable clinical outcomes in 91.5% of patients at the end of therapy visit and 89.2% at the end of study visit 2.
- Levofloxacin: Favorable clinical outcomes in 89.3% of patients at the end of therapy visit and 85.1% at the end of study visit 2.
- Ceftriaxone plus azithromycin: Clinical success rates of 84.3% at the end of therapy and 81.7% at the end of study 3.