Pneumonia Treatment Guidelines

Community-Acquired Pneumonia (CAP)

The British Thoracic Society recommends that outpatients with mild CAP receive amoxicillin as the preferred first-line agent, with macrolides as alternatives for penicillin-allergic patients 1, 2
The British Thoracic Society suggests that amoxicillin should be used at higher doses than previously recommended for optimal coverage of Streptococcus pneumoniae 1, 2
For children under 5 years, the British Thoracic Society recommends amoxicillin as the first choice due to its effectiveness against common pathogens, tolerability, and cost 5
In children aged 5 and above, the British Thoracic Society recommends macrolides as first-line empirical treatment given the higher prevalence of Mycoplasma pneumoniae 5
The Infectious Diseases Society of America recommends combination therapy with a β-lactam antibiotic plus a macrolide for hospitalized patients with moderate severity CAP (CURB-65 score 2-3) 3, 4
The American Thoracic Society recommends that patients with severe CAP requiring ICU admission receive combination therapy with a broad-spectrum β-lactam plus either a macrolide or fluoroquinolone 6, 7

The Society for Healthcare Epidemiology of America recommends monotherapy with an antipseudomonal agent for HAP/VAP with low MDRO risk and stable hemodynamics 3, 4
The Infectious Diseases Society of America recommends combination therapy with an antipseudomonal β-lactam plus either a fluoroquinolone or aminoglycoside for HAP/VAP with high MDRO risk or unstable hemodynamics 3, 4
The American Thoracic Society recommends adding anti-MRSA therapy to gram-negative coverage when MRSA risk is present 3, 4

The Infectious Diseases Society of America recommends that patients with CAP be treated for a minimum of 5 days, be afebrile for 48-72 hours, and have no more than one CAP-associated sign of clinical instability before discontinuing therapy 6
The European Respiratory Society recommends that the treatment duration generally not exceed 8 days in responding patients 8

The American College of Emergency Physicians recommends that the first antibiotic dose be administered while still in the emergency department for hospitalized patients admitted through the emergency department 6
The British Thoracic Society recommends that all patients receive appropriate oxygen therapy with monitoring to maintain PaO₂ >8 kPa and SaO₂ >92% 1, 2
The American Thoracic Society recommends clinical review at approximately 6 weeks post-discharge, either with the general practitioner or in hospital clinic 1, 2
The Infectious Diseases Society of America recommends that pneumococcal and influenza vaccines be administered to appropriate at-risk populations 6, 7