Pneumonia - Medications

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Many patients with heart disease, kidney disease, diabetes, or other co-existing conditions may still be treated as outpatients. However, they should be given a fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin) or a beta-lactam (preferably high-dose amoxicillin or amoxicillin-clavulanate), plus a macrolide, unless they live in an area with high S. pneumoniae resistance to macrolides.

Current recommendations call for 7 - 10 days of treatment for S. pneumoniae and 10 - 14 days for Mycoplasma pneumoniae and Chlamydia pneumoniae. However, some research suggests that patients with mild-to-moderate community-acquired pneumonia may be successfully treated with 7 days or less of antibiotics. The shorter treatment may increase patient tolerance, and improve the likelihood that patients will stick to the treatment regimen. It will also help limit the growing problem of antibiotic resistance.

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For a more detailed discussion of the different types of antibiotics, see the "Antibiotic Classes" section below.

Many cases of community-acquired pneumonia are caused by S. pneumoniae -- Gram-positive bacteria that usually respond to antibiotics known as beta-lactams (which include penicillin), and to macrolides. However, resistant strains of S. pneumoniae are increasingly common. Most resistant strains respond to fluoroquinolines such as levofloxacin (Levaquin), gemifloxacin (Factive), or moxifloxacin (Avelox). Another common cause of community-acquired pneumonia is H. influenzae.

In addition, other important causes of CAP, particularly in younger people, are atypical bacteria, which respond to macrolides (erythromycin, clarithromycin, or azithromycin), ketolides, or newer fluoroquinolones.

Antibiotic treatment for CAP is determined by a number of factors, including:

• The patient's history of antibiotic therapy
• Co-existing diseases (such as COPD, diabetes, and heart failure)
• Whether the patient is well enough to be treated at home or requires hospitalization or nursing home care.

Treatment options can include a single drug, such as levofloxacin or doxycycline, or combination treatment, such as a macrolide administered with a beta-lactam.