What antibiotics are recommended for community-acquired pneumonia (CAP)?

From the Guidelines

For community-acquired pneumonia (CAP), the recommended antibiotics depend on the treatment setting and patient risk factors, with a focus on minimizing morbidity, mortality, and improving quality of life.

Treatment Recommendations

For outpatient treatment of healthy individuals, amoxicillin 1g three times daily for 5 days is the first choice 1. For patients with comorbidities or recent antibiotic use, a respiratory fluoroquinolone (levofloxacin 750mg daily or moxifloxacin 400mg daily) or a combination of amoxicillin-clavulanate 875/125mg twice daily plus a macrolide (azithromycin 500mg on day 1, then 250mg daily for 4 days) is recommended 1.

Key Considerations

• The choice of antibiotic should be based on local resistance patterns, allergies, and clinical response, with narrowing of therapy once culture results are available 1.
• Treatment duration is generally 5-7 days for most patients, with clinical improvement guiding the decision to stop 1.
• The most common CAP pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms like Mycoplasma pneumoniae 1.

Hospitalized Patients

For hospitalized non-ICU patients, ampicillin-sulbactam 3g IV every 6 hours or ceftriaxone 1-2g IV daily plus azithromycin is appropriate 1. ICU patients typically require broader coverage with ceftriaxone plus either azithromycin or a respiratory fluoroquinolone 1.

Quality of Life and Outcomes

The goal of treatment is to minimize morbidity, mortality, and improve quality of life, with a focus on rapid clinical improvement and reduced risk of complications 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

DOSAGE & ADMINISTRATION SECTION Adults Infection *Recommended Dose/Duration of Therapy *DUE TO THE INDICATED ORGANISMS (See INDICATIONS AND USAGE.) Community-acquired pneumonia (mild severity) 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5

Antibiotics for community-acquired pneumonia include:

• Levofloxacin
• Azithromycin These antibiotics are indicated for the treatment of community-acquired pneumonia due to various susceptible microorganisms, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 2 3.

From the Research

Antibiotics for Community-Acquired Pneumonia

• The following antibiotics have been studied for the treatment of community-acquired pneumonia:
  • Levofloxacin: A fluoroquinolone antibiotic that has been shown to be effective in treating community-acquired pneumonia, with a clinical success rate of 94.1% in one study 4.
  • Azithromycin: A macrolide antibiotic that has been used in combination with ceftriaxone to treat community-acquired pneumonia, with a clinical success rate of 92.3% in one study 4.
  • Doxycycline: A tetracycline antibiotic that has been shown to be effective in treating community-acquired pneumonia, with a clinical cure rate similar to that of levofloxacin in one study 5 and comparable to macrolides or fluoroquinolones in another study 6.
  • Ceftriaxone: A cephalosporin antibiotic that has been used in combination with azithromycin to treat community-acquired pneumonia 4.
  • Amoxicillin: A penicillin antibiotic that has been used to treat community-acquired pneumonia, but has been associated with a higher incidence of gastritis and diarrhea compared to clarithromycin, azithromycin, and levofloxacin in one study 7.
  • Clarithromycin: A macrolide antibiotic that has been used to treat community-acquired pneumonia, but has been associated with a higher incidence of adverse events compared to amoxicillin in one study 7.

Efficacy of Antibiotics

• The efficacy of different antibiotics for community-acquired pneumonia has been compared in several studies, with no significant difference in efficacy found between levofloxacin and azithromycin plus ceftriaxone in one study 4.
• Doxycycline has been shown to be as effective as levofloxacin in treating community-acquired pneumonia in one study 5, and comparable to macrolides or fluoroquinolones in another study 6.
• The clinical cure rate for doxycycline was similar to that of macrolides or fluoroquinolones in one study, with a pooled odds ratio of 1.29 (95% CI: 0.73-2.28) 6.

Safety of Antibiotics

• The safety of different antibiotics for community-acquired pneumonia has been compared in several studies, with levofloxacin found to be as well tolerated as azithromycin plus ceftriaxone in one study 4.
• Doxycycline has been found to have a similar adverse event rate to levofloxacin in one study 5, and comparable to macrolides or fluoroquinolones in another study 6.
• Amoxicillin has been associated with a higher incidence of gastritis and diarrhea compared to clarithromycin, azithromycin, and levofloxacin in one study 7.
• Cethromycin has been associated with a higher incidence of nervous system side effects, especially dysgeusia, compared to clarithromycin in one study 7.
• Nemonoxacin has been associated with a higher incidence of gastrointestinal and nervous system adverse events compared to levofloxacin in one study 7.