Antibiotic Guide for Adult Community-acquired pneumonia

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Antibiotic Guide for Adult Community-acquired Pneumonia

Severe community-acquired pneumonia

If patient is likely to have aspirated, anaerobic cover is also required click here.

Co-amoxiclav IV 1.2g tds plus Clarithromycin IV 500mg bd. When clinically improving convert to oral Co-amoxiclav 625mg (Prescribed as Co-amoxiclav 375mg plus amoxicillin 250mg tds) plus Clarithromycin PO 500mg bd

Mild penicillin allergy (eg rash only) Cefuroxime IV 1.5 g tds plus Clarithromycin IV 500mg bd. When clinically improving convert to oral Levofloxacin 500 mg BD monotherapy, no need for clarithromycin.

In severe penicillin allergy:

Vancomycin 1g IV BD (adjust dose if >65 yrs or renal impairment) + Levofloxacin 500 mg po BD. 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.

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 See IV to Po switch guidelines.
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.
Levofloxacin and Clarithromycin both have good activity against atypical pathogens.
Levofloxacin is not available IV. Tablets disperse in water after 10 mins if swallowing is difficult. IV ciprofloxacin is VERY expensive and is a reserved drug on the hospital formulary. If IV therapy is necessary, contact a medical Microbiologist for advice.

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

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.