Severity
(classification)

1st line oral/iv antibiotics

Anaphylactic penicillin allergy
(see explanatory notes)

A

Minor to moderate infection
Review doses in renal impairment

TRIMETHOPRIM 200mg po bd
plus
DOXYCYCLINE 200mg po od

TRIMETHOPRIM 200mg po bd
plus
DOXYCYCLINE 200mg po od

B

Moderate to severe infection

Review doses in renal impairment

CO-AMOXICLAV 625mg po tds
OR
CO-AMOXICLAV 1.2g iv tds if NBM

CLARITHROMYCIN 500mg po bd
plus
GENTAMICIN 5mg/kg iv stat dose
(nb: use 3mg/kg if >65 years old)

If serum creatinine 150-300 micromol/L use:
GENTAMICIN 80-120mg IV stat
GENTAMICIN THERAPY TO BE REVIEWED AFTER FIRST 24HRS. Continue only if evidence of gram –ve sepsis. Check level 12-18hrs after first dose. Continue according to local protocol if required

OR
If gentamicin is contra-indicated (see GHNHSFT protocol) discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist

C

Severe life threatening infection

Review doses in renal impairment

•  Send urine sample to microbiology for legionella antigen test and sputum sample for MC&S

TAZOCIN 4.5g iv tds (monotherapy)

• If definite history of rash allergy but no anaphylactic penicillin allergy (see explanatory notes) or colonised with ESBL producer (see UTI guideline), use:

MEROPENEM 1g iv tds

• If suspected/confirmed MRSA ADD:

Teicoplanin 400mg iv every 12 hours for 3 doses then 600mg iv once daily and review with consultant microbiologist
Maintain treatment pending pre-dose (trough) level on Day 5
Mild to moderate infection (10-20mg/l)
Severe(>20mg/l,<60mg/l)
Re-assay after 6 to 8 days

•  If unresponsive to treatment or previously treated with antibiotics above: discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist.

Note that the antibiotic regimens above provide adequate cover for aspiration pneumonia occurring in hospital 

REVIEW THERAPY with culture results at 48-72 hours. If initial diagnosis of hospital acquired pneumonia is in doubt (i.e. absence of clinical features above) and cultures are negative then consider stopping antibiotics

Discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist

IV to Oral Switch(explanatory notes)

See specific guidelines when diagnosis known or if source remains unknown, use: 
CO-AMOXICLAV 625mg tds

Discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist

Typical duration of therapy for hospital acquired pneumonia is 7- 8 days