Duration of therapy for moderate-severity CAP in adults

If a pathogen is identified in an adult with moderate-severity CAP, see Directed therapy for pneumonia for modification and duration of therapy.

For moderate-severity CAP in adults, the duration of therapy (intravenous + oral) for amoxicillin, doxycycline and clarithromycin is 5 daysLan, 2020; for azithromycin (which has a long intracellular half-life), the duration of therapy is 3 daysRattanasuwan, 2021.

Consider stopping amoxicillin, doxycycline or clarithromycin on review at day 3 if the patient is clinically stable (eg has normal heart rate, respiratory rate, oxygen saturation, and temperature)Dinh, 2021.

Patients who are not clinically stable by day 5 are at higher risk of mortality and worse clinical outcomes – see Approach to managing adults with CAP who are not improving for further considerationsDinh, 2021Royer, 2018Tansarli, 2018Uranga, 2016Vaughn, 2019.

A longer duration of therapy is required for patients with lung abscess, complicated parapneumonic effusion or empyema complicating pneumonia.

For strategies to prevent further episodes of pneumonia, see Prevention of CAP in adults.