12.5 Community Acquired Pneumonia

Type of Infection	First Line (with Dosage and Duration)	Alternative First Line (with dosage and Duration)	Comments
Without comorbidities: OPD management	Amoxicillin 1g q8h for 5-7 days	Azithromycin 500mg OD /Clarithromycin 500mg BD daily Or Doxycycline 100mg BD Duration: 5-7 days	Duration of therapy is 5-7 days, but longer duration of therapy may be considered in patients with bacteremic pneumonia, S. aureus pneumonia, Legionella pneumonia, lung abscess, empyema or other complications. If clinical stability criteria are achieved [ ie absence of fever for 48 hours, hemodynamically stable, no evidence of lung abscess/synpneumonic effusion], antibiotics may be stopped by day 5.
With comorbidities - OPD management	Amoxicillin- clavulanate 1g BD + Doxycycline 100mg BD/ Azithromycin 500mg daily Duration: 5-7 days	Cefuroxime 500 mg BD / Cefpodoxime 200 mg BD + Azithromycin 500 mg daily /Doxycycline 100mg BD Duration: 5-7 days
Inpatient ward	Ceftriaxone 2g OD IV + Azithromycin 500 mg daily /Doxycycline 100mg q12h Duration: 5-7 days	Cefotaxime 1-2 g TDS IV Or Amoxicillin- clavulanate 1.2g q8h + Azithromycin 500 mg daily Or Doxycycline 100mg q12h Duration: 5-7 days
Inpatient ICU	Ceftriaxone 2g OD IV + Azithromycin 500 mg daily Or Doxycycline 100mg q12h Duration: 5-7 days	Cefotaxime 2g TDS IV Or Piperacillin- tazobactam 4.5g IV q6h + Azithromycin 500 mg daily Or Doxycycline 100mg q12h Duration: 5-7 days	Add MRSA agent if Necrotizing pneumonia preceding Influenza infection MRSA agents to be considered: Vancomycin 25 mg/kg IV stat followed by 15mg/kg q8-12h Or Teicoplanin 400 mg twice daily for 3 doses and then 10mg/kg OD Or Linezolid 600 mg BD PO or IV (after TB is excluded)
Inpatient ICU with risk factors for Pseudomonas aeruginosa	Piperacillin- tazobactam 4.5g IV q6h + Azithromycin 500mg daily Or Doxycycline 100mg q12h Duration: 7 days	Imipenem / Meropenem + Azithromycin 500mg daily Or Doxycycline 100mg q12h Duration: 7 days	Risk factors for Pseudomonas infections include: Structural lung disease like bronchiectasis, healthcare exposure or antibiotics in the last 90 days, immunocompromised. Add MRSA agent if Necrotizing pneumonia preceding Influenza infection

For common etiological agents of Community Acquired Pneumonia, see Annexure B.12.5

Additional Information

If Pneumonia not resolving in 2 weeks - rule out TB

References

1. Sharma BB, Singh V. Indian pneumonia guidelines. Lung India. 2012;29(4):307-308. doi:10.4103/0970-2113.102793

2. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community- acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581ST

3. 3. Treatment Guidelines for Antimicrobial Use in Common Syndromes. 2nd edition. ICMR. 2019. New Delhi (Accessed on 2nd April, 2025). Available from: https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource- guidelines/Treatment_Guidelines_2019_Final.pdf