Community-Acquired Pneumonia Treatment Guidelines

Outpatient Treatment

The American Thoracic Society recommends Augmentin (amoxicillin-clavulanate) dosing of 875 mg/125 mg twice daily or 2000 mg/125 mg twice daily for outpatients with comorbidities 1
For outpatients with chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia, Augmentin is recommended 1
Dosing options for outpatients with comorbidities include 500 mg/125 mg three times daily, 875 mg/125 mg twice daily, or 2000 mg/125 mg twice daily 1
Augmentin should be combined with a macrolide (azithromycin or clarithromycin) or doxycycline for atypical pathogen coverage 1, 2

For hospitalized non-ICU patients, the preferred β-lactams are cefotaxime, ceftriaxone, ampicillin-sulbactam, or ceftaroline 3

If a patient has received antibiotics within the past 3 months, an alternative from a different class should be selected 2
For patients with recent β-lactam use, consider a respiratory fluoroquinolone instead 4
High-dose amoxicillin-clavulanate (2000 mg/125 mg twice daily) is effective against S. pneumoniae with reduced susceptibility to penicillin 5

Using standard-dose amoxicillin-clavulanate for areas with high prevalence of drug-resistant S. pneumoniae may lead to treatment failure 5
Monotherapy with Augmentin without atypical coverage (macrolide or doxycycline) may miss atypical pathogens like Mycoplasma pneumoniae or Chlamydophila pneumoniae 2
Augmentin should not be used if the patient has had recent exposure to amoxicillin or amoxicillin-clavulanate due to increased risk of resistance 2
For severe pneumonia requiring ICU admission, Augmentin alone is insufficient; combination therapy with coverage for atypical pathogens is required 3

The American Thoracic Society and Infectious Diseases Society of America recommend a beta-lactam plus macrolide combination for outpatient community-acquired pneumonia with comorbidities, with a strong recommendation and high-quality evidence 6, 7, 8

For patients with comorbidities, the American Thoracic Society and Infectious Diseases Society of America suggest respiratory fluoroquinolone monotherapy as an alternative, with a strong recommendation and high-quality evidence 9
Cefpodoxime monotherapy does not provide adequate coverage for atypical pathogens, and adding a macrolide, such as azithromycin or clarithromycin, is recommended for optimal outcomes in patients with comorbidities 6, 7
Alternative to macrolides, doxycycline can be added, with a recommendation based on evidence 7, 8, 10

For patients with atrial fibrillation, fluoroquinolones carry FDA warnings for cardiac arrhythmias, and should be used with caution 8, 9
Patients with CKD stage 3 require dose adjustment for certain antibiotics, such as levofloxacin and cefpodoxime 9
Recent antibiotic exposure within the past 3 months requires selecting an agent from a different class to reduce resistance risk 6, 7