IV to Oral conversion for Adult Community-acquired Pneumonia

IV Amoxicillin		PO Amoxicillin 500mg-1g tds.
IV Cefuroxime		PO  Co-amoxiclav 375mg with Amoxicillin 250mg tds (Levofloxacin 500mg bd  if penicillin allergic). As Levofloxacin can increase selection for C.difficile infection and MRSA colonisation/infection, all patients with previous MRSA/C.difficile  require microbiology approval to use levofloxacin.
IV Clarithromycin		PO Clarithromycin 500mg bd.
IV Co-amoxiclav		PO  Co-amoxiclav 375mg with Amoxicillin 250mg tds.
IV Metronidazole		PO Metronidazole 400mg tds

Notes

• Review the need for IV antibiotics on the post-take ward round and daily thereafter. Patients initially treated with IV antibiotics should be transferred to oral therapy as soon as clinical improvement occurs and the temperature has been normal for 24 hours.
• Levofloxacin has good activity against atypical pathogens. Addition of macrolides is not usually required.
• Antibiotic treatment should be given for 10 days in total unless legionella, staphylococcal or Gram negative pneumonia suspected or confirmed, in which case, treat for 14 - 21 days.

The Full Guideline "Nottingham Hospitals Antibiotic Guidelines for Adult Patients With Community Acquired Pneumonia" is available here.

Page last edited: 16/10/2009

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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