The Center For Disease Dynamics, Economics & Policy

Mild to Moderate Community-Acquired Pneumonia (CAP) in Ambulatory Outpatients

Clinical definition:

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)
Drug Formulation Dosage Duration
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

5 days
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

5 days
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.

Notes:

  • 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.