From the Guidelines
Community-acquired pneumonia (CAP) should be treated with antibiotics for a minimum of 5 days, with the choice of antibiotic based on the most commonly reported bacterial pathogens, such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
Treatment Strategies
- For non-severe inpatients, treatment may include a β-lactam plus a macrolide or a respiratory fluoroquinolone 1.
- For severe inpatients, treatment may include a β-lactam plus a macrolide or a fluoroquinolone, with additional coverage for MRSA and P. aeruginosa if risk factors are present 1.
- The choice of antibiotic should be guided by the patient's risk factors for antibiotic-resistant pathogens, such as recent hospitalization, parenteral antibiotics, and prior respiratory isolation 1.
Antibiotic Duration
- Extension of therapy after 5 days of antibiotics should be guided by validated measures of clinical stability, including resolution of vital sign abnormalities, ability to eat, and normal mentation 1.
- Current evidence supports the use of shorter-duration antibiotics in the treatment of CAP, with no difference in clinical improvement between short-course and long-course therapy 1.
Key Considerations
- Sputum culture and nasal PCR may be useful in guiding antibiotic therapy, especially in patients with risk factors for antibiotic-resistant pathogens 1.
- Vancomycin or linezolid may be used for MRSA coverage, and piperacillin-tazobactam or ceftazidime may be used for P. aeruginosa coverage 1.
From the Research
Treatment Overview
The treatment for community-acquired pneumonia (CAP) typically involves the use of antibiotics, with the choice of antibiotic depending on the severity of the disease and the suspected or confirmed causative pathogen [(2,3,4,5,6)].
- The goal of treatment is to reach clinical stability and avoid treatment failure, with considerations for de-escalation to avoid antibiotic resistance and the risk of developing subsequent infections 2.
- Effective management of CAP requires risk stratification of patients by severity and proper place of therapy, with additional therapeutic interventions along with antibiotics potentially helping to improve outcomes in patients with CAP, especially in severe CAP 3.
Antibiotic Choices
The choice of antibiotic for CAP is challenging due to the variety of potential pathogens and the spread of drug-resistance 4.
- Empirical antimicrobial regimens, such as macrolides, are still being debated, with new antibiotics and adjunctive therapies (e.g., corticoids) being tested 3.
- New antibiotics have been approved or are in development for the treatment of CAP, including delafloxacin, omadacycline, lefamulin, solithromycin, nemonoxacin, and ceftaroline, which offer activity against methicillin-resistant Staphylococcus aureus and macrolide-resistant Streptococcus pneumoniae [(5,6)].
Treatment Considerations
The treatment of CAP should be based on the knowledge of the most frequently reported etiologies for the different clinical conditions, specific patient risk factors, and the treatment setting 4.
- The awareness of local drug-resistance epidemiology and individual patient characteristics, such as age, history of antibiotic treatments, and underlying diseases, should also be considered 4.
- Adequate CAP management should address other issues, including therapy duration, monitoring of efficacy and adverse effects, and supportive measures 4.