The most common antibiotics for pneumonia include amoxicillin, doxycycline, Augmentin, cefpodoxime, azithromycin, and levofloxacin. Severe cases may require IV antibiotics, such as ceftriaxone, vancomycin, or piperacillin-tazobactam.
The best antibiotic depends on the severity of the infection, the person's age, overall health, and the bacteria involved. Mild cases can usually be treated at home, while severe pneumonia may require hospitalization.
Antibiotics only work against bacterial pneumonia and should be prescribed by a doctor. Treatment usually lasts about 5 days, with symptoms often improving within 2 to 3 days.
List of antibiotics for pneumonia
US guidelines group antibiotics for community-acquired pneumonia according to the person's health and how severe the infection is:
Newer antibiotics, like lefamulin, omadacycline, delafloxacin and ceftobiprole, are also FDA-approved for community-acquired pneumonia and may be considered in specific cases, such as allergies or intolerance to other options.
The doctor chooses the antibiotic and dose after evaluating each person. Doses listed in this article are the usual adult doses and may change for children, older adults and people with kidney problems.
Oral antibiotics for pneumonia
Oral antibiotics are used when pneumonia is mild enough to be treated at home. The main options are:
1. Amoxicillin
Amoxicillin is a penicillin antibiotic and one of the first-choice options for healthy adults with community-acquired pneumonia. It works well against Streptococcus pneumoniae, the most common bacteria behind pneumonia, and is also the most used antibiotic for pneumonia in children.
How to take: the usual adult dose is 1 g three times a day, every 8 hours, with or without food. For children, the pediatrician calculates the dose based on the child's weight.
Side effects: diarrhea, nausea and skin rash are the most common. Hives, swelling of the face or lips and difficulty breathing may indicate a serious allergic reaction and require emergency care.
Contraindications: amoxicillin should not be used by people allergic to penicillin. People with kidney disease may need a lower dose.
2. Doxycycline
Doxycycline is a tetracycline antibiotic that can be used for pneumonia in healthy adults and in people allergic to penicillin. It also acts against "atypical" bacteria, like Mycoplasma pneumoniae, which amoxicillin does not cover.
How to take: the usual dose is 100 mg twice a day, with a full glass of water. It is important to stay upright for at least 30 minutes after each dose and to avoid taking it within 2 hours of antacids, iron, calcium or magnesium supplements.
Side effects: nausea, stomach upset, irritation of the esophagus and greater sensitivity to the sun, which increases the risk of sunburn.
Contraindications: doxycycline is not recommended during pregnancy, for children under 8 years of age, or for people allergic to tetracyclines.
3. Amoxicillin-clavulanate (Augmentin)
Augmentin is a good option for pneumonia in adults with chronic conditions, like COPD, heart disease, diabetes or kidney disease.
Clavulanate protects amoxicillin from enzymes made by some bacteria, like Haemophilus influenzae, which widens the number of bacteria it can treat. For pneumonia, it is usually prescribed together with azithromycin, clarithromycin or doxycycline.
Also recommended: Amoxicillin Clavulanate: Indications, Dosing & Side Effects tuasaude.com/en/amoxicillin-clavulanateHow to take: usual doses are 875 mg/125 mg twice a day, 500 mg/125 mg three times a day, or 2,000 mg/125 mg (extended-release) twice a day. It is best taken at the start of a meal, to reduce stomach upset.
Side effects: diarrhea is more common than with amoxicillin alone. Nausea, vomiting and vaginal yeast infections can also occur, and liver problems are rare.
Contraindications: Augmentin should not be used by people allergic to penicillin or who previously had jaundice or liver problems while taking it.
4. Cefpodoxime and cefuroxime
Cefpodoxime and cefuroxime are oral cephalosporins that can replace Augmentin in adults with chronic conditions. They are also combined with azithromycin, clarithromycin or doxycycline.
How to take: the usual doses are 200 mg of cefpodoxime twice a day or 500 mg of cefuroxime twice a day, preferably with food, which improves absorption.
Side effects: diarrhea, nausea, stomach pain and skin rash.
Contraindications: these antibiotics should not be used by people allergic to cephalosporins. People with a severe allergy to penicillin should tell the doctor before using them.
5. Azithromycin and clarithromycin
Azithromycin and clarithromycin are macrolide antibiotics that act against common and atypical bacteria, like Mycoplasma, Chlamydophila and Legionella.
Also recommended: Azithromycin: Indications, Dosing & Side Effects tuasaude.com/en/azithromycinIn the US, they are rarely used alone for pneumonia, because more than 25% of Streptococcus pneumoniae bacteria in most regions are resistant to them.
They are mainly combined with Augmentin, a cephalosporin or ceftriaxone.
How to take: azithromycin is usually taken as 500 mg on the first day, followed by 250 mg once a day, with or without food.
Clarithromycin is taken as 500 mg twice a day, or 1,000 mg once a day in the extended-release form, which should be taken with food.
Side effects: diarrhea, nausea, stomach pain and, with clarithromycin, a metallic taste in the mouth. Both can change the heart rhythm, which is rare but can be serious.
Contraindications: macrolides should be avoided by people allergic to them, with a history of heart rhythm problems (like a long QT interval) or with liver problems caused by previous use.
Clarithromycin interacts with many medications, like some statins and heart medications, and is avoided during pregnancy when other options exist.
6. Levofloxacin and moxifloxacin
Levofloxacin and moxifloxacin are "respiratory" fluoroquinolones that can be used alone to treat pneumonia in adults with chronic conditions or allergies to other antibiotics.
Because of their side effect risk, they are usually reserved for people who cannot take other options.
How to take: the usual doses are 750 mg of levofloxacin or 400 mg of moxifloxacin once a day, with water. They should be taken at least 2 hours before or after antacids, iron, zinc, calcium or magnesium.
Side effects: nausea, diarrhea, headache and dizziness are the most common. The FDA warns about rare but serious effects, like tendon inflammation or rupture, nerve damage, changes in blood sugar, confusion and mood changes.
Contraindications: fluoroquinolones should not be used by people with myasthenia gravis or previous tendon problems caused by these antibiotics.
They are generally avoided during pregnancy and in people under 18, and should be used with caution by older adults and people taking corticosteroids.
7. Lefamulin (Xenleta)
Lefamulin is a newer antibiotic, from a different class (pleuromutilins), approved by the FDA in 2019 to treat community-acquired bacterial pneumonia in adults.
Also recommended: Bacterial Pneumonia: Symptoms, Causes, How It Spreads & Treatment tuasaude.com/en/bacterial-pneumoniaIt worked as well as moxifloxacin in studies and is usually reserved for people with allergies or resistance to other antibiotics.
How to take: the tablets are usually taken twice a day for 5 days, on an empty stomach, at least 1 hour before or 2 hours after a meal. It is also available as an IV medication in the hospital.
Side effects: diarrhea, nausea and vomiting are the most common, and it can change the heart rhythm.
Contraindications: lefamulin should not be used during pregnancy, as it can harm the baby, or by people with a long QT interval. It also interacts with several medications.
8. Omadacycline (Nuzyra)
Omadacycline is a newer tetracycline antibiotic approved by the FDA to treat community-acquired bacterial pneumonia in adults, available as tablets or IV medication. It acts against bacteria resistant to older tetracyclines.
How to take: the doctor usually prescribes a higher dose on the first day and then once a day. The tablets should be taken on an empty stomach with water, avoiding food for a few hours after and dairy products, antacids and supplements with iron, calcium or magnesium for longer.
Side effects: nausea, vomiting, diarrhea and changes in liver tests. In the pneumonia study, slightly more deaths occurred with omadacycline than with moxifloxacin, so the doctor monitors the response closely.
Contraindications: omadacycline should not be used during pregnancy, in children under 8 years of age, or by people allergic to tetracyclines.
Any of these antibiotics should be stopped and the doctor contacted in case of severe or bloody diarrhea, which may indicate an intestinal infection by Clostridioides difficile.
IV antibiotics for pneumonia
IV antibiotics are given in the hospital when pneumonia is moderate to severe, when the person cannot take pills, or when there is a risk of resistant bacteria. When the person improves, the doctor can usually switch to oral antibiotics to finish treatment at home.
1. Ceftriaxone and other beta-lactams
Ceftriaxone is one of the most used IV antibiotics for pneumonia in the hospital. It is usually given at a dose of 1 to 2 g once a day, combined with azithromycin or clarithromycin.
Other options in this group are ampicillin-sulbactam (Unasyn), cefotaxime and ceftaroline (Teflaro). Ceftaroline also acts against some resistant bacteria, including MRSA.
2. Vancomycin and linezolid
Vancomycin and linezolid are used when there is a risk or confirmation of methicillin-resistant Staphylococcus aureus (MRSA), for example in people recently hospitalized or treated with IV antibiotics.
The dose of vancomycin is calculated based on the person's weight and adjusted with blood tests that measure the medication's levels. Linezolid is usually given at 600 mg every 12 hours, and can also be taken as tablets.
3. Piperacillin-tazobactam, cefepime and carbapenems
When there is a risk of infection by Pseudomonas aeruginosa, such as in people with severe lung disease or recent hospital stays, the doctor may prescribe piperacillin-tazobactam (Zosyn), cefepime, ceftazidime, meropenem, imipenem or aztreonam.
These antibiotics are also commonly used for hospital-acquired pneumonia and pneumonia linked to mechanical ventilation.
Carbapenems, like meropenem and imipenem, do not treat MRSA, so vancomycin or linezolid may be added when this bacteria is suspected.
4. Ceftobiprole
Ceftobiprole (Zevtera) is an IV cephalosporin approved by the FDA in 2024 for community-acquired bacterial pneumonia.
It acts against most bacteria that cause pneumonia, including MRSA, and is usually reserved for specific hospital cases.
How long antibiotics take to work
Most people start to feel better within 2 to 3 days of starting antibiotics. Symptoms like fever, shortness of breath, and mucus production usually begin to improve. However, coughing and tiredness may last for several weeks, even when the treatment is working.
For most adults with community-acquired pneumonia, antibiotic treatment usually lasts 5 days.
According to the American Thoracic Society's 2025 guidelines, people with mild to moderate pneumonia who improve quickly may need as little as 3 days of antibiotics, depending on the doctor's assessment.
Treatment may take longer in people with severe pneumonia, complications such as a lung abscess, or infections caused by bacteria like MRSA or Pseudomonas aeruginosa.
It is important to take antibiotics exactly as prescribed by the doctor, even if symptoms improve before treatment is finished. This helps prevent the infection from coming back and reduces the risk of antibiotic resistance.
Other treatments for pneumonia
Corticosteroids, like hydrocortisone, are not recommended for people hospitalized with non-severe pneumonia.
However, according to the 2025 American Thoracic Society guideline, they may be used in people with severe pneumonia, except when the pneumonia is caused by the flu.
When pneumonia is caused by a virus, antibiotics may not be needed. In healthy adults with a positive test for a respiratory virus, the doctor may decide not to prescribe antibiotics.
People with pneumonia who test positive for the flu should be treated with an antiviral, like oseltamivir (Tamiflu).
Also recommended: tuasaude.com/enDuring treatment, some measures also help with recovery:
- Rest and avoid physical effort until the fever goes away
- Drink plenty of water, to help loosen phlegm
- Eat a balanced diet
- Take fever and pain medication, like acetaminophen, only as directed by the doctor
- Avoid smoking
Some people may also need oxygen, respiratory physical therapy or bronchodilators, especially in the hospital. Vaccines against pneumococcus, the flu, COVID-19 and RSV help prevent new episodes of pneumonia.
Signs of improvement or worsening
Signs that the antibiotic is working usually appear within 2 to 3 days. They include a lower or absent fever, easier breathing, less phlegm and a better appetite and energy.
Pneumonia may be getting worse when the fever persists after 3 days of antibiotics, shortness of breath increases, or the person coughs up blood. Chest pain, confusion, bluish lips or fingertips, a very fast heart rate and low blood pressure, with dizziness or fainting, are also warning signs.
In these cases, it is important to go to the emergency room or call 911 right away. Worsening may mean the bacteria is resistant to the antibiotic, the pneumonia is caused by another germ, or a complication has developed.
Possible complications
Bacterial pneumonia can lead to complications, especially when treatment starts late or the bacteria is resistant to the antibiotic. Fluid or pus can build up around the lungs (pleural effusion or empyema), or an area of the lung can form a pocket of pus (lung abscess). These cases need longer antibiotic treatment and, sometimes, drainage with a needle or chest tube.
In severe cases, bacteria can spread to the blood and cause sepsis, or the lungs can stop delivering enough oxygen to the body, causing respiratory failure. Both are emergencies that require treatment in the hospital, often in the ICU.
Also recommended: Sepsis: Symptoms, Causes & Treatment tuasaude.com/en/sepsisUsing antibiotics without a prescription or stopping them too early also increases the risk of antibiotic resistance, which can make future infections harder to treat.
