From the Guidelines
Walking pneumonia is typically treated with macrolide antibiotics, with azithromycin being the first-line treatment, as recommended by the Infectious Diseases Society of America/American Thoracic Society consensus guidelines 1.
Treatment Options
The standard adult regimen for azithromycin is 500mg on the first day, followed by 250mg daily for 4 more days (5 days total) 1.
- Alternative options include:
- Clarithromycin (500mg twice daily for 7-14 days)
- Doxycycline (100mg twice daily for 7-14 days) for those who cannot take macrolides
Special Considerations
For children, azithromycin is dosed based on weight, typically 10mg/kg on day one followed by 5mg/kg for 4 more days 1.
- Patients with comorbidities or recent antimicrobial therapy may require alternative treatments, such as a respiratory fluoroquinolone or combination therapy with a b-lactam and a macrolide 1.
Supporting Evidence
The guidelines recommend macrolides as the first-line treatment for walking pneumonia due to their effectiveness against Mycoplasma pneumoniae, an atypical bacterium that lacks a cell wall 1.
- The use of fluoroquinolones is discouraged in patients without comorbid conditions or risk factors for DRSP infection due to concerns about resistance 1.
From the FDA Drug Label
1.2 Community-Acquired Pneumonia: 7 to 14 Day Treatment Regimen 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
Treatment of pneumonia 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
1 INDICATIONS AND USAGE
1.1 Community Acquired Pneumonia Moxifloxacin hydrochloride tablets are indicated in adult patients for the treatment of Community Acquired Pneumonia caused by susceptible isolates of Streptococcus pneumoniae (including multi-drug resistant Streptococcus pneumoniae [MDRSP]), Haemophilus influenzae, Moraxella catarrhalis, methicillin-susceptible Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae
Walking pneumonia is often caused by Mycoplasma pneumoniae, which is a type of bacteria.
- Levofloxacin 2 is indicated for the treatment of community-acquired pneumonia due to Mycoplasma pneumoniae.
- Azithromycin 3 is indicated for the treatment of community-acquired pneumonia due to Mycoplasma pneumoniae.
- Moxifloxacin 4 is indicated for the treatment of community-acquired pneumonia due to Mycoplasma pneumoniae. These antibiotics may be used to treat walking pneumonia, but the choice of antibiotic should be based on the specific circumstances of the patient and the severity of the infection.
From the Research
Walking Pneumonia Antibiotics
- Walking pneumonia, also known as atypical pneumonia, is caused by organisms such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella species 5, 6, 7, 8, 9.
- These organisms do not have a bacterial cell wall, making them resistant to β-lactam antibiotics 5, 7.
- The treatment of choice for atypical pneumonia includes macrolides, tetracyclines, and fluoroquinolones 5, 6, 7, 8.
- Macrolides are the first-line antibiotics used in children due to their low minimum inhibitory concentrations and high safety 7.
- However, the incidence of macrolide-resistant M. pneumoniae has been increasing, particularly in Korea, Japan, and China 7, 8.
- Empirical macrolide therapy in children with mild to moderate community-acquired pneumonia may not provide additional benefits over β-lactam monotherapy and can increase the risk of macrolide-resistant M. pneumoniae 7.
- In adults, outpatient treatment of community-acquired pneumonia can include doxycycline, a fluoroquinolone, or a macrolide, while hospitalized adults may require cefotaxime or ceftriaxone plus a macrolide, or a fluoroquinolone alone 6.
- The Japanese pneumonia guidelines propose a differential diagnosis for typical bacterial pneumonia and atypical pneumonia to select an appropriate antibiotic for the management of mild-to-moderate pneumonia 5.