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.