Pneumonia with recent or concurrent influenza
Staph aureus is a more common respiratory pathogen in CAP or HAP if concurrent or recent influenza infection.
Amoxicillin doesn’t have activity against Staph aureus. Co-amoxiclav does have good activity
Clinical deterioration of mild-moderate CAP (i.e. CURB 1 or 2) despite empirical antibiotics – consider adding IV fluclox 1g qds (or IV vancomycin as per guidance if history of MRSA)
- Severe CAP (i.e. ≥CURB 3) – follow CAP (severe) - CURB 65 3-5 guideline as recommended antibiotics will have good Staph aureus activity (consider adding vancomycin as per guidance if history of MRSA)
Post-influenza HAP - follow HAP guidelines (consider adding IV vancomycin if clinical deterioration despite empirical antibiotics or if history of MRSA)