From the Guidelines
Treatment for community-acquired pneumonia in the UK should prioritize oral antibiotics, with co-amoxiclav or a tetracycline as the preferred choice, and alternatives including macrolides or fluoroquinolones for those intolerant of penicillins, as recommended by the British Infection Society, British Thoracic Society, and Health Protection Agency 1.
Key Considerations
- Most patients can be adequately treated with oral antibiotics, with co-amoxiclav or a tetracycline as the first-line choice.
- For patients who are intolerant of penicillins, alternatives include macrolides such as clarithromycin or fluoroquinolones like levofloxacin or moxifloxacin.
- When oral therapy is contraindicated, parenteral options include intravenous co-amoxiclav, cefuroxime, or cefotaxime.
- Antibiotics should be administered within four hours of admission.
Severity-Based Treatment
- For mild CAP, oral antibiotics such as co-amoxiclav or a tetracycline are sufficient.
- For moderate to severe CAP, combination therapy with a beta-lactam antibiotic and a macrolide may be necessary.
- In severe cases requiring intensive care, broader coverage with co-amoxiclav and a macrolide is recommended.
Supportive Care
- Oxygen therapy, adequate hydration, and antipyretics are essential components of supportive care.
- Severity assessment using tools like CURB-65 helps determine the appropriate treatment setting.
Antibiotic Choices
- The chosen antibiotic regimen should target the most common CAP pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms.
- Narrower spectrum options are preferred when possible to reduce antimicrobial resistance, as recommended by the British Infection Society, British Thoracic Society, and Health Protection Agency 1.
From the Research
Treatment Options for Community-Acquired Pneumonia in the UK
- The treatment for community-acquired pneumonia (CAP) in the UK involves the use of antibiotics, with the choice of antibiotic depending on the severity of the disease and the patient's underlying health conditions 2.
- Macrolide monotherapy is currently recommended as first-line treatment of mild-to-moderate CAP in penicillin-intolerant/allergic individuals in the UK, but resistance rates among Streptococcus pneumoniae are increasing 2.
- Alternative agents such as doxycycline and moxifloxacin are being considered as second-line therapy for non-severe CAP 2.
Empiric Antibiotic Treatment
- A network meta-analysis found that cetaroline and piperacillin have the highest probability of being the best empiric antibiotic treatment for cure rate in hospitalized patients with CAP 3.
- For mortality rate, the best empiric antibiotic treatments are ceftriaxone plus levofloxacin, ertapenem, and amikacin plus clarithromycin 3.
- The certainty of evidence for each result is moderate, and further research is needed to compare treatments with the highest probability of being the best for each event (cure or mortality) 3.
Specific Antibiotics
- Clarithromycin is effective against commonly encountered pathogens in CAP and has a established tolerability profile 4.
- A study found that the addition of clarithromycin to the treatment regimen of patients with severe CAP leads to better survival rates compared to other macrolides and fluoroquinolones 5.
- Beta-lactam monotherapy is noninferior to beta-lactam-macrolide combination therapy or fluoroquinolone monotherapy with regard to 90-day mortality in patients with clinically suspected CAP admitted to non-ICU wards 6.
Resistance and Treatment Strategies
- The development and increasing prevalence of antibiotic resistance is a concern in the treatment of CAP, especially in outpatients 4.
- A review of alternative agents such as doxycycline and moxifloxacin is timely due to increasing resistance rates among Streptococcus pneumoniae 2.
- Treatment strategies for CAP should take into account the limited availability of evidence and the need for further research to determine the best empiric antibiotic treatment 3, 6.