Treatment in the outpatient setting

If it is appropriate to treat pneumonia in the outpatient setting, treatment is dictated by the individual's comorbidities and recent exposure to antibiotics.

1^st line: previously healthy patients with no antibiotic use in the last 6 months

• A macrolide (azithromycin or clarithromycin) OR
• doxycycline

2^nd line: outpatients with comorbidities(chronic heart, lung, liver, renal diseases; diabetes; alcoholism; cancer; asplenia) OR antibiotic use in the last 3 months:

• A respiratory fluoroquinolone (levofloxacin, gemifloxacin, moxifloxacin) as monotherapy; please note that ciprofloxacin is NOT a respiratory fluoroquinolone and should not be used to treat pneumonia.
• A beta lactam (high dose amoxicillin, Augmentin, cefpodoxime) PLUS a macrolide as combination therapy

Non-ICU inpatients can be treated with the same regimen listed as "second line" treatment. All ICU patients with be treated with combination therapy. Historically, CAP patients have been treated with 10-14 days of antiomicrobials; however, recent research shows that 7 days of antibiotics may be equally effective (Watkins & Lemonovich, 2011).

 

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