From the Guidelines
Community-acquired pneumonia (CAP) treatment should start with antibiotics that cover common bacterial pathogens, such as Streptococcus pneumoniae, Haemophilus influenzae, and atypical pathogens like Legionella species.
Recommended Antibiotics for CAP
- For healthy adults, recommended options include amoxicillin, doxycycline, or a macrolide (e.g., azithromycin, clarithromycin) 1.
- For patients with comorbidities, a β-lactam with a macrolide or a respiratory fluoroquinolone is recommended 1.
- The choice of antibiotic should be based on effective treatment of the most commonly reported bacterial pathogens and may include an aminopenicillin with clavulanic acid, a macrolide, or a tetracycline 1.
Duration of Antibiotic Therapy
- Antibiotics for CAP should be prescribed for a minimum of 5 days 1.
- Extension of therapy after 5 days of antibiotics should be guided by validated measures of clinical stability, which include resolution of vital sign abnormalities, ability to eat, and normal mentation 1.
Special Considerations
- For patients with suspected aspiration with infection, amoxicillin-clavulanate or clindamycin is recommended 1.
- For patients with influenza and bacterial superinfection, a β-lactam or a respiratory fluoroquinolone is recommended 1.
- In patients with CAP and COVID-19, empirical coverage for bacterial pathogens is recommended, but not required in all patients with confirmed COVID-19–related pneumonia 1.
From the Research
Recommended Antibiotics for Community-Acquired Pneumonia (CAP)
The following antibiotics have been recommended or are being developed for the treatment of CAP:
- Delafloxacin
- Omadacycline
- Lefamulin
- Solithromycin
- Nemonoxacin
- Ceftaroline 2 These antibiotics have activity against methicillin-resistant Staphylococcus aureus and macrolide-resistant Streptococcus pneumoniae.
Narrow-Spectrum Antibiotics
Narrow-spectrum antibiotics, such as macrolides and doxycycline, are recommended for the treatment of CAP in otherwise healthy adults 3, 4.
- Macrolide monotherapy is associated with a lower risk of adverse drug events (ADEs) compared to broad-spectrum antibiotics 3.
- Doxycycline is also a narrow-spectrum antibiotic that can be used to treat CAP 3, 4.
Broad-Spectrum Antibiotics
Broad-spectrum antibiotics, such as fluoroquinolones and β-lactams, are associated with an increased risk of ADEs 3.
- Fluoroquinolones are broad-spectrum antibiotics that can be used to treat CAP, but they are associated with an increased risk of ADEs 3.
- β-lactams are also broad-spectrum antibiotics that can be used to treat CAP, but they are associated with an increased risk of ADEs 3.
Current Treatment Guidelines
Current treatment guidelines for CAP recommend risk stratification of patients by severity and proper place of therapy 4.