Hospital Acquired Pneumonia

Duration

Non-severe: 5 days

Severe: 7 - 10 days

Notes
  • Collect sputum (AND blood cultures in pneumonia)
  • For patients with pneumonia, send urine for legionella antigen and a viral throat swab.
  • Consider diagnosis of influenza and isolate patient according to Patient Placement Tool [intranet only]
  • Always consider prior therapy; patients who have not responded to a recent course of antibiotics should receive an alternative agent

Oral therapy must be considered the norm except in SEVERE pneumonia or in patients unable to take oral therapy

EARLY ≤ 4 days of admission

Use CURB65 score to assess severity and treat as for Community Acquired Pneumonia

Consider immune deficiency and testing for HIV

LATE (≥ 5 days of admission) - Non Severe

Amoxicillin 1g oral 8 hourly

LATE - Non-Severe: Penicillin Allergy

Doxycycline oral 100mg 12 hourly

OR

Co-trimoxazole oral 960mg 12 hourly

LATE - Severe

IV  Co-amoxiclav 1.2g 8 hourly 

If life-threatening,

+ IV Gentamicin¥ (Hartford Regimen) as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app

 

Switch to oral:

Co-amoxiclav 625mg 8 hourly

If MRSA likely, add IV Vancomycin as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app for intermittent dosing

¥If >72 hours IV therapy required replace gentamicin with temocillin IV 2g 12 hourly

LATE - Severe: Penicillin Allergy

Levofloxacin 500mg IV/oral 12 hourly

If MRSA likely, add IV Vancomycin as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app for intermittent dosing