Community-Acquired Pneumonia Treatment Guidelines
Hospitalized Patients
- The Infectious Diseases Society of America recommends combination therapy with a β-lactam plus azithromycin for all hospitalized patients with community-acquired pneumonia, with a recommended regimen of ampicillin-sulbactam, ceftriaxone, or cefotaxime PLUS azithromycin 500 mg daily 1, 2
- Initial therapy should be given intravenously for most admitted patients, according to the Infectious Diseases Society of America 1
- The American Thoracic Society suggests that switch to oral therapy is appropriate when fever has resolved and clinical condition is stable 3
ICU Patients
- The Infectious Diseases Society of America recommends combination therapy with a β-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus either azithromycin or a respiratory fluoroquinolone for ICU patients, representing level II evidence for azithromycin combinations and level I evidence for fluoroquinolone combinations 1
- Combination therapy should continue for at least 48 hours or until diagnostic test results are known, as recommended by the Infectious Diseases Society of America 1
Outpatients with Comorbidities or Risk Factors
- The American College of Physicians recommends combination therapy with high-dose amoxicillin-clavulanate (Augmentin) PLUS azithromycin for outpatients with comorbidities or risk factors, such as age >65 years, COPD, diabetes, renal failure, heart failure, or malignancy 2
- The specific dosing is amoxicillin-clavulanate 2g twice daily PLUS azithromycin 500 mg on day 1, then 250 mg daily for 4 days, as recommended by the American College of Physicians 2
Duration of Therapy
- The Infectious Diseases Society of America recommends that treatment should continue for a minimum of 5 days, with patients being afebrile for 48-72 hours and having no more than one CAP-associated sign of clinical instability before discontinuation 2
- The European Respiratory Society suggests that for atypical pathogens (Mycoplasma, Chlamydophila), extend treatment to 10-14 days 3, 2
- The European Respiratory Society also recommends that for Legionella pneumophila, treatment should last 21 days 3