Duration of antibiotic treatment for community-acquired pneumonia

Abstract

Previous guidelines have recommended 5-day antibiotic treatment for community-acquired pneumonia (CAP) patients manifesting clinical improvement after 48–72 h, and seven-day treatment for other, uncomplicated forms of CAP.

Three meta-analyses and two randomized double-blind trials have confirmed the non-inferiority of short (3–7 days) as compared to long treatments (>7 days). A trial involving young patients with few comorbidities demonstrated the efficacy of 3-day treatment by amoxicillin in the event of clinical improvement at D3. A second trial, which involved older patients with more comorbidities, validated three-day antibiotic treatment by injectable beta-lactams for patients stabilized at D3.

The 2025 guidelines adopt a personalized approach premised on attainment of clinical stability: three days of antibiotic treatment for non-severe or moderate CAP stabilized at D3, five days when stability is achieved by D5, and seven days for other, uncomplicated forms of community-acquired pneumonia. Only when complications occur is prolonged duration indicated.

The ensuing recommendations are aimed at reducing antibiotic exposure while maintaining optimal efficacy of treatment for community-acquired pneumonia.