First-Line Antibiotic Treatment for Community-Acquired Pneumonia (CAP)

Outpatient Treatment

• The American College of Physicians and Infectious Diseases Society of America recommends a macrolide (azithromycin or clarithromycin) or doxycycline as the first-line antibiotic treatment for outpatients with CAP without comorbidities 2
• For outpatients with comorbidities or risk factors for drug-resistant pathogens, the American College of Physicians and Infectious Diseases Society of America recommends either a respiratory fluoroquinolone or a combination of a β-lactam plus a macrolide 2, 3

Inpatient Treatment

• The Infectious Diseases Society of America recommends a respiratory fluoroquinolone (levofloxacin, moxifloxacin) or a β-lactam (cefotaxime, ceftriaxone, or ampicillin) plus a macrolide for inpatient treatment of CAP 1, 4

Severe CAP (ICU Treatment)

• The Infectious Diseases Society of America recommends a β-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus either azithromycin or a respiratory fluoroquinolone for severe CAP treatment in the ICU 4, 5

Duration of Treatment

• The European Respiratory Society recommends that treatment duration should generally not exceed 8 days in responding patients 6

Caveats and Special Considerations

• The Infectious Diseases Society of America recommends considering alternative regimens in regions with high rates (>25%) of macrolide-resistant S. pneumoniae, even for patients without comorbidities 2
• The Infectious Diseases Society of America recommends selecting an antibiotic from a different class if there has been recent antibiotic use within the previous 3 months 2
• The American College of Physicians recommends initiating antibiotics as soon as possible after diagnosis of CAP, particularly in patients with septic shock 6