Hospital Acquired Pneumonia (HAP)

Micro-organism

Mixed organisms including anaerobes

Duration

Total duration (IV/oral): 7 days

First Line

Dependant on microbiology/recent antibiotics. Discuss with microbiologist if clinically indicated

IV Co-amoxiclav 1.2g 8hourly + ORAL Clarithromycin1 500mg 12 hourly

+/- IV Gentamicin3

+/- IV Vancomycin3

Stepping down to

ORAL Co-amoxiclav 625mg 8 hourly + Clarithromycin1 500mg 12 hourly

Penicillin Allergy

Dependant on microbiology/recent antibiotics. Discuss with microbiologist if clinically indicated

IV Levofloxacin1,4  500mg 12 hourly (consider switch to oral after 24 hours)

+/- Vancomycin3

Stepping down to

ORAL  Levofloxacin1 500mg 12 hourly

Notes

Occurring > 48hrs post-admission or within 10 days of discharge

 

Doses may need to be adjusted in renal impairment. Always check BNF for interactions. Seek advice if patient pregnant

Drug specific cautions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid Doxycycline and Co-trimoxazole if pregnant or breast feeding
  3. Gentamicin/Vancomycin refer to online calculators
  4. ALERT antibiotic needs ALERT form
  5. Monitor sodium
  6. See CURB65 definition
  7. Reference: The Renal Drug Handbook 4th Edition, 2014