Treatment of Other Bacterial Pneumonia in Adults Admitted with Nonsevere Community-Acquired Pneumonia
This page covers empiric antibiotic selection for adult inpatients presenting with nonsevere community-acquired pneumonia who do not carry risk factors for drug-resistant organisms.
Clinical Scenario
Adult inpatient with nonsevere community-acquired pneumonia (CAP) and no risk factors for MRSA or Pseudomonas aeruginosa: no prior respiratory isolation of MRSA or P. aeruginosa, and no recent hospitalisation with receipt of parenteral antibiotics within the preceding 90 days.
Empiric Treatment Approach
Guideline-recommended strategies include combination therapy pairing a β-lactam with a macrolide, or monotherapy with a respiratory fluoroquinolone. A third pathway is available for patients with contraindications to both macrolide and fluoroquinolone classes.
Specific agents, doses, step-down criteria, and the complete management algorithm are in the full protocol.
Treatment Goals
The endpoint is clinical stability — resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, temperature), ability to eat, and normal mentation. Stability is typically expected within 48–72 hours and formally assessed by day 5.
References
DOI: 10.1164/rccm.201908-1581ST
- In inpatient adults with nonsevere CAP without risk factors for MRSA or P. aeruginosa (see Recommendation 11), we recommend the following empiric treatment regimens (in no order of preference) (Table 4):
- combination therapy with a b-lactam (ampicillin + sulbactam 1.5–3 g every 6 h, cefotaxime 1–2 g every 8 h, ceftriaxone 1–2 g daily, or ceftaroline 600 mg every 12 h) and a macrolide (azithromycin 500 mg daily or clarithromycin 500 mg twice daily) (strong recommendation, high quality of evidence), or
- monotherapy with a respiratory fluoroquinolone (levofloxacin 750 mg daily, moxifloxacin 400 mg daily) (strong recommendation, high quality of evidence).
- A third option for adults with CAP who have contraindications to both macrolides and fluoroquinolones is:
- combination therapy with a b-lactam (ampicillin + sulbactam, cefotaxime, ceftaroline, or ceftriaxone, doses as above) and doxycycline 100 mg twice daily (conditional recommendation, low quality of evidence).
- Risk factors include prior respiratory isolation of MRSA or P. aeruginosa or recent hospitalization AND receipt of parenteral antibiotics (in the last 90 d).
- We recommend that the duration of antibiotic therapy should be guided by a validated measure of clinical stability (resolution of vital sign abnormalities [heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature], ability to eat, and normal mentation), and antibiotic therapy should be continued until the patient achieves stability and for no less than a total of 5 days (strong recommendation, moderate quality of evidence).