Severe Community-Acquired Pneumonia for Hospitalized Patients

Clinical definition:

Severe disease is defined as CURB-65 score greater than two and requires hospitalization.


Preferred antibiotic choice(s)
Drug Formulation Dosage Duration
Combination therapy with:

Ceftriaxone (IV/IM)


Cefotaxime (IV/IM)




Azithromycin (PO)

Ceftriaxone- Powder for injection: 250 mg; 1 g (as sodium salt) in vial 2 g daily 5 days
Cefotaxime – Powder for injection: 250 mg per vial (as sodium salt 2 g 8 hourly 5 days
Clarithromycin- Solid oral dosage form: 500 mg;

Powder for oral liquid: 125 mg/5 mL; 250 mg/5 mL;

Powder for injection: 500 mg in vial


500 mg by mouth 12 hourly

5 days
Azithromycin- Capsule: 250 mg; 500 mg (anhydrous); Oral liquid: 200 mg/5 mL 500 mg daily 5 days
In case of confirmed drug allergy or medical contraindication
Moxifloxacin (IV/PO) Tablet: 400 mg; Tablet (dispersible): 100 mg; Injectable solution: 400mg/250 mL3 400 mg daily 5 days


Principles of Stewardship:

  • Obtain a blood culture prior to starting antibiotic therapy.
  • If available, perform a legionella urinary antigen test – a positive result will allow stopping of the b-lactam and extension of azithromycin to a minimum of 7 days to treat pneumophilia
  • In high TB-endemic areas, assess patients presenting with fever and cough with or without constitutional symptoms (anorexia, weight loss, night sweats) for active TB disease.
  • Doxycycline may be used in place of a macrolide if unavailable.