NEJM Practice Guideline Community-Acquired Pneumonia

Persistent Notes

  • for outpatient treatment, it depends on if patient has comorbidity or not.
    • no comorbidity and young: amoxicillin, doxycycline, azithromycin
    • comorbidity or old: augmentin and macrolide/doxycycline. Can use fluoroquinolone as alternative

Highlights

  • Severe CAP p.634
  • Septic shock p.634
  • Respiratory failure p.634
  • amoxicillin (1 g three times daily), doxycycline (100 mg twice daily), or a macrolide (azithromycin at a dose of 500 mg on day 1, then 250 mg daily, or clarithromycin at a dose of 500 mg twice daily [extendedrelease, 1000 mg daily]). p.636
  • amoxicillin–clavulanate (875 mg orally twice daily [extended-release, 2 g twice daily]) and either a macrolide (preferred) or doxycycline are recommended. p.636
  • fluoroquinolone (levofloxacin at a dose of 750 mg daily or moxifloxacin at a dose of 400 mg daily) or one of two more recently approved agents, lefamulin or omadacycline p.636
  • Treatment should usually continue for a minimum of 5 days; p.639
  • Extended courses of therapy may be indicated for patients with immunocompromising conditions, infections caused by certain pathogens (e.g., P. aeruginosa), or complications such as empyema. p.639

Reference

File TM, Ramirez JA. NEJM Practice Guideline Community-Acquired Pneumonia. O’Malley PG, ed. N Engl J Med. 2023;389(7):632-641. doi:10.1056/NEJMcp2303286