This protocol addresses the management of Streptococcus pneumoniae pneumonia in adults presenting with community-acquired pneumonia (CAP) who are treated in the outpatient setting and have no underlying chronic diseases or known risk factors for antibiotic-resistant pathogens.
Adult with community-acquired pneumonia managed in the outpatient setting. No chronic heart disease, chronic lung disease, chronic liver disease, or chronic renal disease. No diabetes mellitus, alcoholism, malignancy, or asplenia. No prior respiratory isolation of MRSA or Pseudomonas aeruginosa.
Oral antibiotic therapy is recommended for this population, with agent selection guided in part by local resistance surveillance data. The complete structured regimen — including all preferred and alternative agents and their selection criteria — is available via the link below.
Achievement of clinical stability — resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature), ability to eat, and normal mentation — generally within the first 48 to 72 hours and by 5 days.
DOI: 10.1164/rccm.201908-1581ST
For healthy outpatient adults without comorbidities listed below or risk factors for antibiotic resistant pathogens, we recommend (Table 3):
Comorbidities include chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia.
Risk factors include prior respiratory isolation of MRSA or P. aeruginosa or recent hospitalization AND receipt of parenteral antibiotics (in the last 90 d).
amoxicillin 1 g three times daily (strong recommendation, moderate quality of evidence), or doxycycline 100 mg twice daily (conditional recommendation, low quality of evidence), or a macrolide (azithromycin 500 mg on first day then 250 mg daily or clarithromycin 500 mg twice daily) only in areas with pneumococcal resistance to macrolides <25% (conditional recommendation, moderate quality of evidence).
Amoxicillin 1 g three times daily, doxycycline 100 mg twice daily, azithromycin 500 mg on first day then 250 mg daily, clarithromycin 500 mg twice daily, or clarithromycin ER 1,000 mg daily.
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).
As most patients will achieve clinical stability within the first 48 to 72 hours, a total duration of therapy of 5 days will be appropriate for most patients.
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