Antibiotic Guide for Adult Hospital-acquired pneumonia

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Antibiotic Guide for Adult Hospital-acquired Pneumonia

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)

Severe hospital-acquired pneumonia (or known MRSA colonisation)

Co-amoxiclav IV 1.2g tds + single dose Gentamicin IV 5mg/kg (to a maximum 500mg - reduce dose in renal impairment) infused over 20-30 minutes. Further doses of Gentamicin may be required if the patient is still unwell with signs of severe disease the following day. Further doses according to 18-24 hour trough level.
Convert to Co-amoxiclav PO 625mg tds (prescribed as Co-amoxiclav 375mg plus Amoxicillin 250mg) - see IV to PO guideline for 5 -7 days total course.

If mild penicillin allergy (rash only):

Cefuroxime IV 1.5g tds for 5 to 7 days + single dose Gentamicin IV 5mg/kg (to a maximum 500mg - reduce dose in renal impairment) infused over 20-30 minutes. Add Metronidazole IV 500mg tds if aspiration of concern.
Convert to oral Levofloxacin 500mg bd +/- Metronidazole 400mg as per IV to PO switch guideline. 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 anaphylaxis with penicillins:

Levofloxacin PO 500mg bd + Vancomycin IV 1g bd (adjust dose if >65 yrs or renal impairment; monitor levels) for 5 to 7 days. Add Metronidazole IV 500mg tds if aspiration of concern.

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 anaphylaxis with penicillins and NBM : discuss choice with microbiology.

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

The Full Guideline "Nottingham Hospitals Antibiotic Guidelines for Adult Patients With Hospital Acquired Lower Respiratory Tract Infection and Aspiration 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.