Management of moderate-severity CAP in adults

Empirical therapy for community-acquired pneumonia (CAP) in adults is stratified according to disease severity – see Severity assessment of CAP in adults. Patients with moderate-severity CAP require close clinical observation so are usually managed in hospital.

Note: Patients with moderate-severity CAP require close clinical observation so are usually managed in hospital.

For adults with sepsis or septic shock, or who require intensive care support, see High-severity CAP in adults.

For residents of an aged-care facility, if treatment in the facility is being considered, see Community-acquired pneumonia in residents of an aged-care facility.

For adults with low-severity CAP who have been admitted to hospital for increased support (eg due to complex comorbidities or social circumstances) or management of another concurrent medical problem, see Low-severity CAP in adults.

For adults with moderate-severity CAP, identify the pathogen if possible – see Investigations for CAP in adults. If a viral respiratory pathogen is suspected, see Empirical antiviral therapy for suspected viral moderate-severity CAP in adults.

For adults with COPD or bronchiectasis who have moderate-severity CAP, no change to standard empirical antibiotic therapy is required – for more information, see Considerations in managing CAP in adults with chronic obstructive pulmonary disease (COPD) or bronchiectasis.

Antibiotic regimens for CAP in these guidelines can be used for initial treatment of aspiration pneumonia – see Management of a patient who has had an aspiration event. However, empirical therapy (eg doxycycline, azithromycin, clarithromycin) used for its activity against atypical pathogens¹ (eg Mycoplasma pneumoniae, Chlamydophila [Chlamydia] pneumoniae) is only required for aspiration pneumonia if the patient has high-severity CAPSimpson, 2023 Neill, 2019.

Antibiotic regimens in this topic can be used for adults with moderate-severity CAP who are in a tropical region of Australia² unless the patient has risk factors for Burkholderia pseudomallei or Acinetobacter baumannii. See Empirical therapy for moderate-severity CAP in adults in tropical regions of Australia for risk factors and management.

For additional considerations in adults with moderate-severity CAP, see:

¹ There is no universally accepted definition of atypical pathogens. The term is used to describe bacteria that are intrinsically resistant to beta lactams and not identifiable by standard blood or sputum culturesGarin, 2022.Return

² Tropical regions of Australia refer to regions north of 20°S latitude. This includes areas of Queensland north of Mackay, the Northern Territory north of Tennant Creek, and Western Australia north of Port Hedland.Return