From the Guidelines
For community-acquired pneumonia (CAP) being discharged from the hospital, I recommend amoxicillin 1 g three times daily as first-line therapy for healthy outpatient adults without comorbidities or risk factors for antibiotic-resistant pathogens, as suggested by the American Thoracic Society and Infectious Diseases Society of America guideline 1. When considering treatment options, it's essential to categorize patients based on their health status and risk factors.
- For healthy outpatient adults, the options include:
- Amoxicillin 1 g three times daily (strong recommendation, moderate quality of evidence) 1
- Doxycycline 100 mg twice daily (conditional recommendation, low quality of evidence) 1
- A macrolide, such as azithromycin, but only in areas with pneumococcal resistance to macrolides of 25% or higher (conditional recommendation, moderate quality of evidence) 1
- For outpatient adults with comorbidities, such as chronic heart, lung, liver, or renal disease, the recommended treatment options are:
- Combination therapy with amoxicillin/clavulanate and a macrolide, or
- Monotherapy with a respiratory fluoroquinolone, such as levofloxacin 750 mg daily (strong recommendation, moderate quality of evidence) 1 It's crucial to individualize treatment based on the patient's clinical response and to instruct patients to complete the full course of antibiotics, even if they are feeling better, to ensure optimal outcomes and minimize the risk of antibiotic resistance. The choice of antibiotic should be guided by local resistance patterns and the patient's specific risk factors, as outlined in the guideline 1.
From the FDA Drug Label
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 DOSAGE AND ADMINISTRATION Type of Infection Dose Every 24 hours Duration (days) Community Acquired Pneumonia (1.1) 400 mg7 to 14 DOSAGE AND ADMINISTRATION Type of Infection Dose Every 24 hours Duration (days) Community Acquired Pneumonia (1.1) 400 mg7 to 14
For the treatment of community-acquired pneumonia, the following options can be considered:
- Azithromycin: 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 2
- Levofloxacin: 500 mg every 24 hours for 7 to 14 days
- Moxifloxacin: 400 mg every 24 hours for 7 to 14 days 3
From the Research
Discharge Community Acquired Pneumonia Treatment
- The treatment for discharge community acquired pneumonia can include doxycycline, as it has been shown to be effective in mild-to-moderate cases 4.
- Azithromycin can be prescribed for atypical antimicrobial cover in severe community-acquired pneumonia, but its use should be carefully considered due to the risk of QTc interval prolongation and antimicrobial resistance 5.
- Beta-lactam monotherapy, beta-lactam-macrolide combination therapy, or fluoroquinolone monotherapy can be used as empirical treatment for patients with clinically suspected community-acquired pneumonia 6.
Dosage and Duration
- The dosage and duration of treatment will depend on the specific antibiotic prescribed and the severity of the pneumonia.
- For doxycycline, the typical dosage is 100mg every 12 hours for 7-14 days 4.
- For azithromycin, the typical dosage is 500mg on the first day, followed by 250mg per day for 4-5 days 5.
- For beta-lactam monotherapy, the typical dosage will depend on the specific antibiotic used, but treatment is usually given for 7-14 days 6.
Discharge Criteria
- Patients can be discharged early if they have had reversal of their metabolic problems and stabilization of comorbid conditions, and have not developed any serious pneumonia-related complications 7.
- Parameters to watch include vital signs and white blood cell count, and patients can be switched to oral therapy if these parameters are improving, even if they have not returned to normal 7.