Community-Acquired Pneumonia Treatment Guidelines

Initial Assessment and Treatment Approach

The American College of Physicians recommends that severity assessment should guide the decision between outpatient versus inpatient treatment, using tools like CURB-65 or the Pneumonia Severity Index (PSI) 2, 3
The Infectious Diseases Society of America suggests that the initial site of treatment should follow a 3-step process: (1) assessment of preexisting conditions that compromise safety of home care; (2) calculation of the PSI with recommendation for home care for risk classes I, II, and III; and (3) clinical judgment 4
The American College of Emergency Physicians recommends that for patients admitted through the emergency department, the first antibiotic dose should be administered while still in the ED to minimize time to treatment 3
The Society of Critical Care Medicine recommends that all admitted patients should receive their first dose of antibiotic therapy within 8 hours of arrival to the hospital 5

The American Academy of Family Physicians recommends that for previously healthy adults without comorbidities or recent antibiotic use, first choice should be Amoxicillin 1 g three times daily 1
The Infectious Diseases Society of America suggests that for adults with comorbidities, an advanced macrolide or a respiratory fluoroquinolone should be used 4, 3

The American Thoracic Society recommends that preferred regimen should be β-lactam (ampicillin/sulbactam, cefotaxime, ceftriaxone, or ceftaroline) PLUS a macrolide (azithromycin or clarithromycin) 1, 4
The Society of Hospital Medicine suggests that most non-severe inpatients can be adequately treated with oral antibiotics when clinically appropriate 3

The American College of Chest Physicians recommends that for patients without risk factors for Pseudomonas aeruginosa, non-antipseudomonal β-lactam (ceftriaxone, cefotaxime) PLUS either a macrolide or a respiratory fluoroquinolone should be used 1, 6
The Infectious Diseases Society of America suggests that for patients with risk factors for Pseudomonas aeruginosa, antipseudomonal β-lactam (cefepime, ceftazidime, piperacillin-tazobactam, meropenem) PLUS either ciprofloxacin OR a macrolide plus aminoglycoside should be used 1, 6

The American Thoracic Society recommends that the duration of therapy is generally 5-7 days for responding patients 1
The Society of Critical Care Medicine suggests that patients should be switched from intravenous to oral therapy when they are hemodynamically stable and improving clinically 3
The American College of Physicians recommends that criteria for switch to oral therapy include: improvement in cough and dyspnea, afebrile, decreasing white blood cell count, and functioning gastrointestinal tract with adequate oral intake 5, 3

The Infectious Diseases Society of America recommends that for suspected or confirmed Legionella, treatment options include respiratory fluoroquinolone (levofloxacin preferred) or macrolide (azithromycin preferred) 1
The American Academy of Family Physicians suggests that for Mycoplasma or Chlamydophila, treatment options include macrolide, doxycycline, or respiratory fluoroquinolone 1

The American College of Emergency Physicians recommends that delayed antibiotic administration can increase mortality; ensure timely administration 1
The Infectious Diseases Society of America suggests that inadequate coverage of causative pathogens is associated with worse outcomes 1
The Society of Critical Care Medicine recommends that for patients who fail to improve as expected, conduct a careful review of the clinical history, examination, prescription chart, and results of all available investigations 3
The American Thoracic Society suggests that up to 10% of all CAP patients will not respond to initial therapy, requiring diagnostic evaluation for drug-resistant or unusual pathogens, nonpneumonia diagnoses, or pneumonia complications 5

The American Academy of Family Physicians recommends that clinical review should be arranged for all patients at around 6 weeks, either with their general practitioner or in a hospital clinic 3
The American College of Chest Physicians suggests that a chest radiograph should be arranged at follow-up for patients with persistent symptoms or physical signs, or who are at higher risk of underlying malignancy 3
The American Thoracic Society recommends that pneumonia can be prevented by pneumococcal and influenza vaccines in appropriate at-risk populations 5