From the Guidelines
Pneumonia treatment should be initiated as soon as possible, with empiric antimicrobial treatment guided by the individual risk of mortality, general patterns of expected pathogens, and regional and local patterns of microbial resistance, as recommended by the most recent guidelines 1. The management of pneumonia involves a combination of antimicrobial treatment, supportive care, and prevention strategies.
- Antimicrobial treatment should be empiric and initiated as soon as possible, with the choice of antibiotics guided by the severity of pneumonia, individual risk factors, and local patterns of microbial resistance 1.
- Supportive care includes rest, adequate hydration (at least 2-3 liters daily), fever reduction with acetaminophen (up to 1000mg every 6 hours), and using a humidifier.
- Prevention strategies include vaccination (pneumococcal and annual flu vaccines), good hand hygiene, avoiding smoking, and maintaining overall health. The diagnosis of pneumonia can be challenging, and clinical parameters cannot always reliably define the microbiologic etiology of pneumonia 1.
- A lower respiratory tract sample for culture should be collected from all intubated patients when the diagnosis of pneumonia is being considered, to guide empiric antibiotic therapy and minimize the risk of inappropriate treatment 1.
- The bacteriologic approach to diagnosis, which involves the use of quantitative cultures and microscopic examination of lower respiratory tract samples, can help guide antibiotic therapy and reduce the risk of overtreatment with antibiotics 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 Azithromycin is effective in treating community-acquired pneumonia caused by specific bacteria, including Streptococcus pneumoniae, in patients who are suitable for oral therapy.
- Key points:
- Community-acquired pneumonia: Azithromycin is effective against Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, and Streptococcus pneumoniae.
- Oral therapy: Azithromycin should only be used in patients who are appropriate for oral therapy, excluding those with moderate to severe illness or certain risk factors. 2
From the Research
Pneumonia Treatment
- Pneumonia is a common and potentially serious illness that requires antibiotic therapy and organ support as needed 3.
- The most frequent microorganism isolated in community-acquired pneumonia (CAP) is Streptococcus pneumoniae 3.
- Combination antibiotic therapy, including β-lactams or macrolides or fluoroquinolones alone or in combination, achieves a better outcome compared with monotherapy in certain patients with CAP 3.
Antibiotic Therapy
- Azithromycin 1g once daily for 3 days is at least as effective as amoxicillin-clavulanate 875/125 mg twice daily for 7 days in the treatment of adult patients with community-acquired pneumonia 4.
- Azithromycin is equally effective as treatment of atypical pneumonia in adult patients if given for 3 or 5 days at the same total dose 5.
- Amoxicillin/clavulanate therapy eradicates or suppresses all strains of S. pneumoniae susceptible to penicillin, while azithromycin therapy clears two-thirds of azithromycin-susceptible strains of S. pneumoniae 6.
Bacterial Pneumonia
- Determining the etiology and selecting antibiotic therapy for bacterial pneumonia are challenging for physicians 7.
- The coronavirus disease pandemic revealed the importance of prevention and treatment of secondary bacterial pneumonia in patients hospitalized with viral respiratory infections 7.
- Macrolides have shown different properties other than antimicrobial activity, such as anti-inflammatory properties, which can be beneficial in the treatment of CAP 3.