What is the treatment for pneumonia?

From the Guidelines

Pneumonia treatment typically involves the administration of antimicrobial therapy, with the specific medication and duration of treatment dependent on the severity and causative pathogen of the infection.

Treatment Options

• For mild to moderate community-acquired pneumonia, a short-course of antibiotics (≤ 6 days) is as effective as long courses, with fewer serious adverse events and low mortality 1.
• Recommended antibiotics for outpatients include macrolides, doxycycline, or fluoroquinolones with enhanced activity against S. pneumoniae 1.
• For patients who are hospitalized, the recommendation is administration of a fluoroquinolone alone or an extended-spectrum cephalosporin (cefotaxime or ceftriaxone) plus a macrolide 1.
• In more severe cases, intravenous antibiotics such as ceftriaxone (1-2g every 12-24 hours) or levofloxacin (500-750mg every 24 hours) may be necessary, with treatment duration typically ranging from 7-14 days 1.

Duration of Treatment

• The duration of treatment should be 7-10 days in classical bacterial infection or uncomplicated community-acquired pneumonia (CAP) 1.
• For suspected or proven M. pneumoniae or C. pneumoniae infection, the duration of treatment should be 10-14 days 1.
• For suspected or proven L. pneumophila or S. aureus infection or severe CAP, the duration of treatment should be 21 days 1.

Route of Administration

• The route of administration should be switched from i.v. to oral when fever has resolved and clinical condition is stable 1.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of levofloxacin tablets and other antibacterial drugs, levofloxacin tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria

1. 1 Nosocomial Pneumonia Levofloxacin tablets are indicated for the treatment of nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae.
2. 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 Treatment of pneumonia In the treatment of pneumonia, azithromycin has only been shown to be safe and effective in the treatment of community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy

The treatment for pneumonia includes:

• Levofloxacin for nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae 2
• Levofloxacin for community-acquired pneumonia due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae 2
• Azithromycin for community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy 3

From the Research

Treatment Options for Pneumonia

• Antibiotic treatment is a common approach for pneumonia, with various options available depending on the severity and type of pneumonia 4, 5, 6, 7, 8
• A single 2.0-g dose of azithromycin microspheres has been shown to be as effective as a 7-day course of extended-release clarithromycin in treating mild-to-moderate community-acquired pneumonia (CAP) 4
• A 750-mg, 5-day course of levofloxacin has been found to be at least as effective as a 500-mg, 10-day regimen for atypical CAP, with more rapid symptom resolution 5
• Once-daily intramuscular ceftriaxone has been successfully used for the outpatient treatment of severe community-acquired bacterial pneumonias in children 6
• The optimal duration of antibiotic treatment for CAP has not been well established, but guidelines suggest treatment for a minimum of 5 days, with the possibility of stopping treatment if the patient shows significant clinical improvement 7
• Ceftriaxone dosages of 1 g daily have been found to be as safe and effective as other antibiotic regimens for community-acquired pneumonia, with no significant difference in clinical outcomes compared to higher dosages 8

Antibiotic Regimens

• Azithromycin microspheres: a single 2.0-g dose 4
• Clarithromycin: extended-release formulation, 1.0 g/d for 7 days 4
• Levofloxacin: 750-mg, 5-day course 5
• Ceftriaxone: once-daily intramuscular, 1 g daily 6, 8
• Ceftriaxone: 2 g daily 8

Clinical Outcomes

• Clinical cure rates: 92.6% for azithromycin microspheres, 94.7% for extended-release clarithromycin 4
• Clinical success rates: 95.5% for 750-mg levofloxacin, 96.5% for 500-mg levofloxacin 5
• Cure rate: 96.6% for once-daily intramuscular ceftriaxone in children 6
• Clinical success rates: 48.6% for control group, 56.3% for intervention group at day 10 7
• Odds ratio of clinical cure: 0.98 for ceftriaxone 1 g daily, 1.03 for comparator regimens 8