CAP (severe) - CURB 65 3-5

First Line

Co-amoxiclav 1.2g IV 8 hourly AND Clarithromycin 500mg IV 12 hourly (if atypical pneumonia suspected / confirmed)

De-escalate to PO co-amoxiclav +/- clarithromycin when clinically improving

Penicillin Allergy

Vancomycin IV as per protocol AND Ciprofloxacin 500mg bd PO / 400mg IV 12 hourly

Ciprofloxacin covers legionella spp. 

Notes

Send relevant samples for C+S and atypical microbiology - see attachment

Minimum duration of treament - 7-10 days

Check travel history and animal (especially birds) exposure