Pneumonia with onset in patients not admitted to the hospital. Mild to moderate disease severity is treated in the outpatient setting.
|Preferred antibiotic choice(s)|
|Amoxicillin (PO)||Amoxicillin- Powder for oral liquid: 125 mg (as trihydrate)/5 mL; 250 mg (as trihydrate)/5 mL; Solid oral dosage form: 250 mg; 500 mg (as trihydrate)||1 g 8 hourly||5 days|
|Alternative antibiotic choice(s)|
|Doxycycline (PO)||Oral liquid: 25 mg/5 mL; 50 mg/5 mL (anhydrous); Solid oral dosage form: 50 mg;100 mg (as hyclate)||
100 mg 12 hourly
|In patients with severe comorbidities (Alcoholism, chronic obstructive pulmonary disease, witnessed aspiration which is progressing after 24 – 48 hours, etc.)|
|Amoxicillin + clavulanic acid (PO)||Oral liquid: 125 mg amoxicillin + 31.25 mg clavulanic acid/5 mL AND 250 mg amoxicillin + 62.5 mg clavulanic acid/5 mL; Tablet: 500 mg (as trihydrate) + 125 mg (as potassium salt)||
500 mg component of amoxicillin 8 hourly
|In case of confirmed drug allergy or medical contraindication|
|Azithromycin (PO)A||Capsule: 250 mg; 500 mg (anhydrous); Oral liquid: 200 mg/5 mL||500 mg daily||3 days|
A. Macrolides should be avoided in countries with high macrolide resistance rates in pneumoniae and should rather be reserved for treatment of patients with penicillin allergy.
Principles of Stewardship:
- Fluoroquinolones should be avoided, particularly in TB-endemic countries.
- A blood culture is preferred to sputum culture if the patient is admitted to hospital.
- If azithromycin or another macrolide is not available, treat with a quinolone such as moxifloxacin or levofloxacin.