From the Guidelines
Pneumonia treatment should prioritize the use of antibiotics such as a macrolide, doxycycline, or fluoroquinolone for outpatients, and a fluoroquinolone alone or an extended-spectrum cephalosporin plus a macrolide for hospitalized patients, as recommended by the Infectious Diseases Society of America 1. When managing community-acquired pneumonia, it is essential to consider the severity of illness, pathogen probabilities, resistance patterns, and comorbid conditions.
- For outpatients, administration of a macrolide, doxycycline, or fluoroquinolone with enhanced activity against S. pneumoniae is recommended 1.
- For patients who are hospitalized, the recommendation is administration of a fluoroquinolone alone or an extended-spectrum cephalosporin (cefotaxime or ceftriaxone) plus a macrolide 1.
- Patients hospitalized in the intensive care unit (ICU) should receive ceftriaxone, cefotaxime, ampicillin-sulbactam, or piperacillin-tazobactam in combination with a fluoroquinolone or macrolide 1. Intravenous antibiotics may be switched to oral agents when the patient is improving clinically, is hemodynamically stable, and is able to ingest drugs, as suggested by the Infectious Diseases Society of America 1.
- Most patients show a clinical response within 3–5 days, and changes evident on chest radiographs usually lag behind the clinical response 1.
- The British Thoracic Society also recommends empirical antibiotic choice for adults hospitalized with severe community-acquired pneumonia, including parenteral antibiotics and a combination of a broad-spectrum β-lactamase stable antibiotic with a macrolide 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
- Pneumonia treatment: Azithromycin is effective for community-acquired pneumonia due to specific bacteria, including Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, and Streptococcus pneumoniae.
- Limitations: 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.
- Key consideration: The decision to use azithromycin for pneumonia treatment should be based on the patient's specific condition and the causative pathogen 2.
From the Research
Treatment Options for Pneumonia
- The treatment of pneumonia can involve various antibiotic regimens, with the choice of treatment depending on the severity and cause of the pneumonia 3, 4, 5, 6.
- Studies have compared the efficacy of different antibiotic combinations, including azithromycin plus ceftriaxone, levofloxacin, and azithromycin plus β-lactam versus levofloxacin plus β-lactam 3, 4, 5, 6.
Efficacy of Antibiotic Combinations
- A study found that azithromycin plus ceftriaxone was at least as efficacious as levofloxacin in the treatment of hospitalized patients with moderate to severe community-acquired pneumonia 3.
- Another study found that levofloxacin monotherapy was as effective as a combination regimen of azithromycin and ceftriaxone in providing coverage against the current causative pathogens in community-acquired pneumonia 4.
- A retrospective nationwide database analysis found no significant differences in 28-day mortality and in-hospital mortality between azithromycin plus β-lactam and levofloxacin plus β-lactam for severe community-acquired pneumonia patients 6.
Safety and Tolerability
- The safety and tolerability of antibiotic combinations have also been evaluated, with studies finding that levofloxacin was as well tolerated as azithromycin and ceftriaxone 3, 4.
- A study found that the incidence of drug-related adverse events was similar between levofloxacin and azithromycin plus ceftriaxone 4.
Clinical Outcomes
- Clinical outcomes, including clinical success rates and microbiologic eradication rates, have been evaluated in various studies 3, 4, 5, 6.
- A study found that the clinical success rate was 94.1% in the levofloxacin group and 92.3% in the azithromycin group 4.
- Another study found that the posttherapy microbiologic eradication rates were 89.5% and 92.3% for levofloxacin and azithromycin, respectively 4.