Antibiotic Guide for Adult Hospital-acquired Pneumonia

Review diagnosis with Chest -Xray if there is no consolidation use non-pneumonic guidance which has a lower risk of C.Diff

Clinical features

• New infiltrates on chest X-ray (occurring >48 hrs after hospital admission)
• Purulent sputum or tracheal secretions
• Core temperature >38.3^oC
• Increased oxygen requirements
• Leucocytosis (>11 x 10⁹/L) or leucopenia (<4 x 10⁹/L)

Mild/moderate hospital-acquired pneumonia (not known to be MRSA carrier)

• Co-amoxiclav PO 625mg tds (prescribed as Co-amoxiclav  375mg plus Amoxicillin 250mg) for 5 to 7 days

   

  • If NBM: Co-amoxiclav IV 1.2g tds (Reduce dose if renal impairment.) change to oral as above ASAP, total course 5 to 7 days
  • If penicillin allergy: Levofloxacin PO 500mg od for 5 to 7 days (Reduce dose if renal impairment). 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.
  • If penicillin allergy (rash only) and NBM: Cefuroxime IV 1.5g tds  (add metronidazole IV 500 mg tds if aspiration of concern)
   
  • Contact microbiology if anaphylaxis with penicillins or cephalosporin allergy and NBM.

Notes

• Take samples prior to starting antibiotics:

  • Sputum for culture (if productive cough or produced after physiotherapy if antibiotic therapy won’t be delayed).
  • Blood cultures
  • Sputum or throat swab for viral culture and immunofluorescence if immunocompromised patient or features suggestive of influenza infection during influenza season

• Antibiotic treatment should be reviewed at 48 hours when microbiology results become available

Page last edited: 09/10/2009

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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