Which class of antibiotics is recommended first-line for community-acquired pneumonia without comorbidity in adults under 60?

Macrolides are recommended as the first-line treatment for community-acquired pneumonia (CAP) in adults under 60 who do not have comorbidities. This is largely due to their efficacy against Streptococcus pneumoniae and atypical pathogens, which are common causes of CAP in otherwise healthy adults. Macrolides, such as azithromycin and clarithromycin, have a favorable side effect profile and good oral bioavailability, making them convenient choices for outpatient treatment.

In cases of community-acquired pneumonia, the goal is to target the most likely pathogens, and macrolides effectively address the typical and atypical bacteria involved. This makes them particularly useful in younger patients without underlying health issues, who typically have a lower risk of infection with resistant organisms that may require alternative or broader-spectrum antibiotics.

While other classes of antibiotics may be used in specific circumstances or for different patient populations, the evidence supports the use of macrolides as the first-line choice for uncomplicated community-acquired pneumonia in this demographic.