From the Guidelines
Community-acquired pneumonia (CAP) treatment should be based on empiric antibiotic therapy, considering the severity of illness, presence of coexisting illness, and risk factors for drug-resistant and unusual pathogens 1.
Key Considerations
- The initial approach to managing patients with CAP involves determining the presence of relevant factors that influence the likely etiologic pathogens, including place of therapy, cardiopulmonary disease, and risk factors for drug-resistant pneumococci and enteric gram-negative bacteria 1.
- Antibiotic options for adult outpatients with CAP include macrolides, doxycycline, and 'respiratory' fluoroquinolones, with the choice depending on patient characteristics and risk factors 1.
- For patients with modifying factors, such as chronic obstructive airway disease (COAD), recent antibiotic or steroid use, or other underlying conditions, broader-spectrum antibiotics may be necessary, including oral cefpodoxime, cefuroxime, high-dose amoxicillin, or amoxicillin-clavulanate 1.
- Hospitalization may be required for patients with severe CAP, and the decision to hospitalize should be based on factors such as the severity of illness, presence of coexisting illness, and ability to manage the patient safely as an outpatient 1.
Empiric Antibiotic Therapy
- Macrolides, such as azithromycin or clarithromycin, are recommended for outpatient treatment of CAP in patients without modifying factors 1.
- Doxycycline is an alternative option for outpatient treatment, particularly in patients with penicillin allergy or intolerance 1.
- 'Respiratory' fluoroquinolones, such as levofloxacin or moxifloxacin, may be used in patients with modifying factors or in those who have failed initial therapy with a macrolide or doxycycline 1.
Future Research Directions
- Further studies are needed to determine the optimal duration of antibiotic therapy for CAP, as well as the impact of antibiotic resistance on treatment outcomes 1.
- The development of rapid, cost-effective, sensitive, and specific diagnostic tests to identify the causative organisms of CAP could improve treatment outcomes and reduce antibiotic resistance 1.
From the Research
Treatment of Community-Acquired Pneumonia (CAP)
The treatment of CAP involves several factors, including:
- The choice of antimicrobials, which is difficult due to the variety of potential pathogens and the spread of drug-resistance 2
- The knowledge of the most frequently reported etiologies for the different clinical conditions, specific patient risk factors, and the treatment setting (home, hospital, intensive or non-intensive care unit) chosen accordingly 2
- The awareness of the local drug-resistance epidemiology and individual patient characteristics, such as age, history of antibiotic treatments and related adverse events, underlying diseases, concurrent therapies, and expected adherence to treatment 2
Antimicrobial Regimens
Some empirical antimicrobial regimens for CAP include:
- Macrolides, which are still being debated 3
- Beta-lactam monotherapy for uncomplicated outpatients 4
- Beta-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for hospitalized patients without risk factors for resistant bacteria 5
Adjunctive Therapies
Adjunctive therapies for CAP may include:
- Corticosteroids, which are not recommended as routine adjunct therapy 4
- Systemic corticosteroid administration within 24 hours of development of severe CAP, which may reduce 28-day mortality 5
New Antibiotics
New antibiotics have been developed for the treatment of CAP, including:
- Delafloxacin, omadacycline, lefamulin, solithromycin, nemonoxacin, and ceftaroline, which have activity against methicillin-resistant Staphylococcus aureus and macrolide-resistant Streptococcus pneumoniae 6