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Community-Acquired Pneumonia

Updated : November 27, 2022





Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

cefotaxime

1 g IM or IV given every 12hrs for mild conditions
1-2 g IM or IV every 8hrs moderate to severe infections
2 g IV every 6-8hrs high dosing for infections
2 g IV every 4hrs for life-threatening infections
12 g is the maximum dose required per day



cefotetan

1-2 g IV or IM every 12hrs for moderate infections
2 g IV every 12hrs for Severe infections
3 g IV every 12hrs for Life-threatening infections
The maximum duration of therapy is seven days



omadacycline

Loading Dose: 200 mg via IV infusion for 1 hour on day 1 or 100 mg via IV infusion for 30mins two times on day 1 or 300 mg orally two times on day 1
Maintenance Dose: 100 mg via IV infusion for 30mins per day or 300 mg orally per day
the maximum duration of treatment is 7-14 days



cefaclor

500

mg

Tablet

Orally 

every 8 hrs

5

days

Extend the therapy duration as per vital signs



ceftriaxone

1-2 g IV or IM was given once a day or in equally divided doses 2x a day
maximum duration of therapy is 4-14 days
prolonged treatment recommends for complicated infections
At least treatment given ten days for diseases due to streptococcus



telithromycin 

800

mg

Orally 

once a day

7 - 10

days



cefpodoxime 

200

mg

Orally 

every 12 hrs

14

days


Note: It is indicated for Acute Community-Acquired Pneumonia.



lefamulin 

Indicated for Community Acquired Bacterial Pneumonia (CABP)
150 mg IV 2 times a day for 5-7 days
or
600 mg orally 2 times a day for 5 days



clarithromycin 

500 mg oral tablet immediate release twice a day for a minimum of 5 days



azithromycin 

The drug treats pneumonia acquired due to various bacterial infections
500 mg orally once a day, followed by 250 mg 4 times a day, on the 2nd to 5th day



linezolid 

600 mg oral/IV 2 times daily 10-14 days



moxifloxacin 

400

mg

Tablet

Intravenous (IV)

every day

7 - 14

days



gemifloxacin 

(M. pneumoniae; S. pneumoniae; C. pneumoniae; H. influenzae): 320mg orally every day for five days
(Multidrug-resistant K. pneumoniae; S. pneumoniae; M. catarrhalis): 320mg orally every day for 7 days



aztreonam 

1-2g intramuscular or intravenous every 8 to 12 hours
Do not exceed 8g/day



azithromycin 

Day 1: 500 mg orally in a single dosage;
Days 2–5: 250 mg orally per day



meropenem 

(Off Label):


Fluoroquinolone and 500 mg intravenously every 8 hours for around five days



cefditoren 

Take 400 mg orally after every 12 hours up to 14 days. Take 200 mg orally after every 12 hours up to 10 days
Renal Impairment For creatinine clearance of 30 to 49 ml/minute/1.73 square meter: maximum up to 200 mg orally after every 12 hours For creatinine clearance of <30 ml/minute/1.73/square meter: every day 200 mg orally End-stage: dose not determined yet



ceftaroline 

600

mg

Intravenous (IV)

twice a day

5 - 14

days



solithromycin 

Pending for FDA approval



cefoperazone 

1 to 2 grams intravenous/intramuscular given every 2 times a day



roxithromycin 

300 mg in single dose or two divided doses every day



cefamandole 

Administer dose of 500 mg intramuscularly or intravenously every 6 hours



sparfloxacin 

100 to 300 mg orally daily, as a single or two divided doses



Dose Adjustments

Dosing modifications
Renal impairment:
Dose adjustment is required in case of severe impairment

loracarbef 

Mild-moderate- Take 400 mg two times a day for two weeks by oral route



faropenem medoxomil 

200 mg taken orally 3 times a day for two weeks



pheneticillin 

Take oral dose as per physicians advised



cefetamet 

Indicated for Pneumonia, Tracheobronchitis, Urinary tract infections:


Administer 500mg to 1g twice a day.



ceftizoxime 

The usual dose for the treatment of pneumonia is 1 to 4 g via Intravenous or Intramuscular administration two or four times a day for up to 7 or 21 days
The duration of the treatment depends on the severity and the nature of the infections. If the infection is severe, the dose can be increased up to 12 g per day



Dose Adjustments

Renal Dose Adjustment
In case of renal insufficiency, the usual dose of ceftizoxime depends on the CrCl. If the CrCl is below 5 mL/min, then 0.25-0.5 g a day or 0.5-1 g via IV or IM in 2 days after undergoing dialysis. Loading dose is standard in renal insufficiency, which is 0.5-1 g. 0.25 -1g twice a day if CrCl falls between 5 and 49 mL/min and 0.5 – 1.5 g thrice a day if CrCl is between 50 and 79 mL/min

dirithromycin 

500 mg is given orally once every day for two weeks



trovafloxacin 

200

mg

Intravenous (IV)

once a day

200mg intravenous or oral for one day, followed by 200mg oral per day for one to two weeks.



cethromycin 

It is indicated as prophylactic treatment of inhalation anthrax, tularemia caused by Francisella tularensis, and plague caused by Yersinia pestis



amoxicillin and clavulanate potassium 

Indicated for Aspirational pneumonia
:

500 mg orally 3 times a day or 875 mg orally 2 times a day
Depending on the type and severity of the infection, therapy should be continued until the infiltrate is removed or a residual scar forms, which could take up to four months



 

linezolid 

600 mg oral/IV 2 times daily 10-14 days



aztreonam 

≤7 days:
<2kg bodyweight: 30mg/kg intravenous every 12 hours
>2 kg bodyweight: 30mg/kg intravenous every 8 hours

8 to 30 days:
<1.2kg: 30mg/kg intravenous every 12 hours
1.2kg-2kg: 30mg/kg intravenous every 8 hours
>2kg: 30mg/kg intravenous every 6 hours
1 to 18 years: 30mg/kg intravenous every 6-8 hours



cefazolin 

Indicated for mild to severe infections:


>3 months:
150mg/kg/day intravenous/intramuscular divided every 8 hours



azithromycin 

6 months: Safety and effectiveness are not yet proven
For six months, administer 10 mg/kg orally x 1 dosage on Day 1 and then 5 mg/kg orally on Days 2–5.



doxycycline 

Children >8 years and adolescents:

1 to 2 mg/kg per dose twice a day for 10 days



ceftaroline 

Age: 2 months-<2 years:

8

mg/kg

Intravenous (IV)

every 8 hrs

5 - 14

days



Age: ≥2 years-<18 years; wt: ≤33 kg: 12 mg/kg Intravenous (IV) every 8 hrs 5-14 days

Age: 2-18 years; wt: >33 kg: 400 mg Intravenous (IV) every 8 hrs OR 600 mg Intravenous (IV) every 8 hrs 5-14 days

Age: ≥18 years: 600 mg Intravenous (IV) every 8 hrs 5-7 days



solithromycin 

Pending for FDA approval



roxithromycin 

Children up to 12 years: 5 to 8 mg/kg in two divided doses every day; maximum dose: 150 mg 2 times a day



cefamandole 

for infants and Children:
Administer daily dose of 50 to 100 mg/kg intramuscularly or intravenously divided doses every 4 to 8 hours



bacitracin 

If the child's weight falls below 2.5 kg, give 900/units/kg/day Intramuscular injection twice daily
If the weight falls above 2.5 kg, give 1000 units/kg/day Intramuscular injection twice daily
For children, administer 800-1200 units/kg/day three times a day



pheneticillin 

For 13 to 18 years old:
Take oral dose as per physicians advised



dirithromycin 

above 12 years: 500 mg is given orally once every day for two weeks



amoxicillin and clavulanate potassium 

Age: < 3 months
For infants under 12 weeks:
Administer 15 mg per kilogram orally 2 times daily with 125 mg/5 mL oral suspension

Age: >3 months
For children weighing less than 40 kg:
With 125 mg/5 mL or 250 mg/5 mL oral suspension, administer orally 3 times daily at a dosage range of 6.67 to 13.33 mg per kilogram
With 200 mg/5 mL or 400 mg/5 mL oral suspension or chewable tablets, administer orally 2 times daily at a dosage range of 12.5 to 22.5 mg per kilogram

For children weighing 40 kg or more:
Immediate release tablets: Administer 500 mg orally every 8 hours or 875 mg orally 2 times daily
Extended release tablets: 2 g orally 2 times daily for 7 to 10 days in cases of community-acquired pneumonia



 

solithromycin 

Pending for FDA approval



Media Gallary

References

Community-Acquired Pneumonia

Updated : November 27, 2022




cefotaxime

1 g IM or IV given every 12hrs for mild conditions
1-2 g IM or IV every 8hrs moderate to severe infections
2 g IV every 6-8hrs high dosing for infections
2 g IV every 4hrs for life-threatening infections
12 g is the maximum dose required per day



cefotetan

1-2 g IV or IM every 12hrs for moderate infections
2 g IV every 12hrs for Severe infections
3 g IV every 12hrs for Life-threatening infections
The maximum duration of therapy is seven days



omadacycline

Loading Dose: 200 mg via IV infusion for 1 hour on day 1 or 100 mg via IV infusion for 30mins two times on day 1 or 300 mg orally two times on day 1
Maintenance Dose: 100 mg via IV infusion for 30mins per day or 300 mg orally per day
the maximum duration of treatment is 7-14 days



cefaclor

500

mg

Tablet

Orally 

every 8 hrs

5

days

Extend the therapy duration as per vital signs



ceftriaxone

1-2 g IV or IM was given once a day or in equally divided doses 2x a day
maximum duration of therapy is 4-14 days
prolonged treatment recommends for complicated infections
At least treatment given ten days for diseases due to streptococcus



telithromycin 

800

mg

Orally 

once a day

7 - 10

days



cefpodoxime 

200

mg

Orally 

every 12 hrs

14

days


Note: It is indicated for Acute Community-Acquired Pneumonia.



lefamulin 

Indicated for Community Acquired Bacterial Pneumonia (CABP)
150 mg IV 2 times a day for 5-7 days
or
600 mg orally 2 times a day for 5 days



clarithromycin 

500 mg oral tablet immediate release twice a day for a minimum of 5 days



azithromycin 

The drug treats pneumonia acquired due to various bacterial infections
500 mg orally once a day, followed by 250 mg 4 times a day, on the 2nd to 5th day



linezolid 

600 mg oral/IV 2 times daily 10-14 days



moxifloxacin 

400

mg

Tablet

Intravenous (IV)

every day

7 - 14

days



gemifloxacin 

(M. pneumoniae; S. pneumoniae; C. pneumoniae; H. influenzae): 320mg orally every day for five days
(Multidrug-resistant K. pneumoniae; S. pneumoniae; M. catarrhalis): 320mg orally every day for 7 days



aztreonam 

1-2g intramuscular or intravenous every 8 to 12 hours
Do not exceed 8g/day



azithromycin 

Day 1: 500 mg orally in a single dosage;
Days 2–5: 250 mg orally per day



meropenem 

(Off Label):


Fluoroquinolone and 500 mg intravenously every 8 hours for around five days



cefditoren 

Take 400 mg orally after every 12 hours up to 14 days. Take 200 mg orally after every 12 hours up to 10 days
Renal Impairment For creatinine clearance of 30 to 49 ml/minute/1.73 square meter: maximum up to 200 mg orally after every 12 hours For creatinine clearance of <30 ml/minute/1.73/square meter: every day 200 mg orally End-stage: dose not determined yet



ceftaroline 

600

mg

Intravenous (IV)

twice a day

5 - 14

days



solithromycin 

Pending for FDA approval



cefoperazone 

1 to 2 grams intravenous/intramuscular given every 2 times a day



roxithromycin 

300 mg in single dose or two divided doses every day



cefamandole 

Administer dose of 500 mg intramuscularly or intravenously every 6 hours



sparfloxacin 

100 to 300 mg orally daily, as a single or two divided doses



Dose Adjustments

Dosing modifications
Renal impairment:
Dose adjustment is required in case of severe impairment

loracarbef 

Mild-moderate- Take 400 mg two times a day for two weeks by oral route



faropenem medoxomil 

200 mg taken orally 3 times a day for two weeks



pheneticillin 

Take oral dose as per physicians advised



cefetamet 

Indicated for Pneumonia, Tracheobronchitis, Urinary tract infections:


Administer 500mg to 1g twice a day.



ceftizoxime 

The usual dose for the treatment of pneumonia is 1 to 4 g via Intravenous or Intramuscular administration two or four times a day for up to 7 or 21 days
The duration of the treatment depends on the severity and the nature of the infections. If the infection is severe, the dose can be increased up to 12 g per day



Dose Adjustments

Renal Dose Adjustment
In case of renal insufficiency, the usual dose of ceftizoxime depends on the CrCl. If the CrCl is below 5 mL/min, then 0.25-0.5 g a day or 0.5-1 g via IV or IM in 2 days after undergoing dialysis. Loading dose is standard in renal insufficiency, which is 0.5-1 g. 0.25 -1g twice a day if CrCl falls between 5 and 49 mL/min and 0.5 – 1.5 g thrice a day if CrCl is between 50 and 79 mL/min

dirithromycin 

500 mg is given orally once every day for two weeks



trovafloxacin 

200

mg

Intravenous (IV)

once a day

200mg intravenous or oral for one day, followed by 200mg oral per day for one to two weeks.



cethromycin 

It is indicated as prophylactic treatment of inhalation anthrax, tularemia caused by Francisella tularensis, and plague caused by Yersinia pestis



amoxicillin and clavulanate potassium 

Indicated for Aspirational pneumonia
:

500 mg orally 3 times a day or 875 mg orally 2 times a day
Depending on the type and severity of the infection, therapy should be continued until the infiltrate is removed or a residual scar forms, which could take up to four months



linezolid 

600 mg oral/IV 2 times daily 10-14 days



aztreonam 

≤7 days:
<2kg bodyweight: 30mg/kg intravenous every 12 hours
>2 kg bodyweight: 30mg/kg intravenous every 8 hours

8 to 30 days:
<1.2kg: 30mg/kg intravenous every 12 hours
1.2kg-2kg: 30mg/kg intravenous every 8 hours
>2kg: 30mg/kg intravenous every 6 hours
1 to 18 years: 30mg/kg intravenous every 6-8 hours



cefazolin 

Indicated for mild to severe infections:


>3 months:
150mg/kg/day intravenous/intramuscular divided every 8 hours



azithromycin 

6 months: Safety and effectiveness are not yet proven
For six months, administer 10 mg/kg orally x 1 dosage on Day 1 and then 5 mg/kg orally on Days 2–5.



doxycycline 

Children >8 years and adolescents:

1 to 2 mg/kg per dose twice a day for 10 days



ceftaroline 

Age: 2 months-<2 years:

8

mg/kg

Intravenous (IV)

every 8 hrs

5 - 14

days



Age: ≥2 years-<18 years; wt: ≤33 kg: 12 mg/kg Intravenous (IV) every 8 hrs 5-14 days

Age: 2-18 years; wt: >33 kg: 400 mg Intravenous (IV) every 8 hrs OR 600 mg Intravenous (IV) every 8 hrs 5-14 days

Age: ≥18 years: 600 mg Intravenous (IV) every 8 hrs 5-7 days



solithromycin 

Pending for FDA approval



roxithromycin 

Children up to 12 years: 5 to 8 mg/kg in two divided doses every day; maximum dose: 150 mg 2 times a day



cefamandole 

for infants and Children:
Administer daily dose of 50 to 100 mg/kg intramuscularly or intravenously divided doses every 4 to 8 hours