What is the treatment for Community-Acquired Pneumonia (CAP)?

From the Guidelines

Community-acquired pneumonia (CAP) should be treated with antibiotics based on severity and patient factors, with a focus on reducing morbidity, mortality, and improving quality of life. For outpatient treatment of mild to moderate CAP, amoxicillin 1g three times daily for 5-7 days is recommended as first-line therapy 1. Alternatives include doxycycline 100mg twice daily or azithromycin 500mg on day one followed by 250mg daily for 4 more days. For patients with comorbidities or risk factors for drug-resistant pathogens, consider amoxicillin-clavulanate 875/125mg twice daily or a respiratory fluoroquinolone like levofloxacin 750mg daily.

Key Considerations

• The choice of antibiotics targets the most common CAP pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms like Mycoplasma pneumoniae, while considering local resistance patterns 1.
• Severe CAP requiring hospitalization typically needs intravenous therapy with a beta-lactam (ceftriaxone 1-2g daily or ampicillin-sulbactam 3g every 6 hours) plus a macrolide or a respiratory fluoroquinolone alone 1.
• Supportive care including oxygen therapy, hydration, and fever management is essential.
• Treatment should be reassessed after 48-72 hours, and therapy can be switched from IV to oral once the patient shows clinical improvement.

Patient Factors

• Comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; or other risks for DRSP infection should be considered when choosing antibiotics 1.
• Recent antimicrobial use should also be taken into account when selecting empirical therapeutic options 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 1.3 Community-Acquired Pneumonia: 5 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (excluding multi-drug-resistant isolates [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae

Treatment of Community-Acquired Pneumonia (CAP):

• Levofloxacin can be used to treat CAP caused by susceptible isolates of certain microorganisms, including Streptococcus pneumoniae, Haemophilus influenzae, and others.
• The recommended treatment regimen is 7 to 14 days for CAP due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including MDRSP), and other specified microorganisms.
• A 5-day treatment regimen is also indicated for CAP due to Streptococcus pneumoniae (excluding MDRSP), Haemophilus influenzae, and other specified microorganisms. 2 2 2

From the Research

Treatment Options for Community-Acquired Pneumonia (CAP)

• CAP can be treated with various antibiotic regimens, including β-lactams, doxycycline, azithromycin, and fluoroquinolones 3, 4, 5.
• The choice of antibiotic regimen depends on the severity of the disease, patient comorbidities, and local resistance patterns.

Severe CAP Treatment

• A study comparing doxycycline and azithromycin in addition to β-lactam therapy for severe CAP found no significant difference in outcomes, including in-hospital and 30-day mortality 3.
• This suggests that doxycycline can be considered as an alternative regimen for severe CAP.

Outpatient CAP Treatment

• A study comparing the safety of different antibiotic regimens for outpatient CAP found that broad-spectrum antibiotics were associated with an increased risk of adverse drug events (ADEs) compared to narrow-spectrum regimens 4.
• The study suggests that narrow-spectrum antibiotics, such as doxycycline, may be a safer option for outpatient CAP treatment.

Doxycycline Efficacy

• A systematic review and meta-analysis of randomized controlled trials found that doxycycline was effective for mild-to-moderate CAP, with a clinical cure rate similar to that of macrolides and fluoroquinolones 5.
• The review suggests that doxycycline is a viable treatment option for mild-to-moderate CAP.

Azithromycin Prescribing

• A study found that azithromycin was often prescribed inappropriately for CAP, without electrocardiograms to assess the QTc interval and without meeting criteria for severe CAP based on CURB-65 score 6.
• This highlights the need for appropriate prescribing practices to minimize unnecessary risks and costs associated with azithromycin use.