Oral therapy for moderate-severity CAP in adults

For management considerations, including adjustments to empirical therapy (eg in tropical regions of Australia1), see Management of moderate-severity CAP in adults.

For adults with moderate-severity CAP who can tolerate and absorb oral therapy and have appropriate clinical review, oral amoxicillin can be used as initial therapy instead of intravenous benzylpenicillin because it has good bioavailability (approximately 70%). As a 2-drug regimen, useAl-Salloum, 2021Aldhahri, 2022Choi, 2022Hill, 2020Patel, 2020Polgreen, 2018:

amoxicillin 1 g orally, 8-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment. The usual duration of therapy is 5 days; see advice on patient review and duration of therapy amoxicillin amoxicillin amoxicillin

PLUS one of the following

1doxycycline 100 mg orally, 12-hourly. The usual duration of therapy is 5 days; see advice on patient review and duration of therapy doxycycline doxycycline doxycycline

OR

2azithromycin 500 mg orally, daily for 3 days. See advice on patient review azithromycin azithromycin azithromycin

OR

2clarithromycin 500 mg orally, 12-hourly. For dosage adjustment in adults with kidney impairment, see clarithromycin dosage adjustment. The usual duration of therapy is 5 days; see advice on patient review and duration of therapy. clarithromycin clarithromycin clarithromycin

For adults with moderate-severity CAP who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, replace amoxicillin in the above regimen with:

cefuroxime 500 mg orally, 12-hourly. For dosage adjustment in adults with kidney impairment, see cefuroxime dosage adjustment. The usual duration of therapy is 5 days; see advice on patient review and duration of therapy2. cefuroxime cefuroxime cefuroxime

For adults with moderate-severity CAP who have had a severe (immediate or delayed)3 hypersensitivity reaction to a penicillin, as monotherapy, use:

moxifloxacin 400 mg orally, daily. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. The usual duration of therapy is 5 days; see advice on patient review and duration of therapy. moxifloxacin moxifloxacin moxifloxacin

1 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
2 Cefuroxime is preferred to cefalexin or cefaclor because of its superior antipneumococcal activity; see Practical information on using beta lactams: cephalosporins for further information.Return
3 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return