Hospital Acquired Pneumonia

Antimicrobial prescribing: NHS Borders
NHS Borders

Duration

5 days and review

Early Onset - within 48 hours of hospital admission

Therapy

Treat as Community Acquired Pneumonia

Notes:

Late Onset - more than 48 hours from hospital admission

Therapy

Low Severity

Doxycycline 200mg oral on first day then 100mg daily

OR

Co-trimoxazole 960mg oral 12 hourly

High Severity

Amoxicillin 1g IV 8 hourly

+

Gentamicin  IV (Extended Interval Dosing as per guideline. Use gentamicin calculator). Max 3 days then review.

 

Penicillin allergy OR previous MRSA

Vancomycin (dosing as per guideline. Use vancomycin calculator)

+

Gentamicin IV (Extended Interval Dosing as per guideline. Use gentamicin calculator). Max 3 days then review.

 

Notes:

IV to Oral Switch

Therapy

Doxycycline 200mg oral on first day then 100mg daily

OR

Co-trimoxazole 960mg oral 12 hourly

Notes:

Notes

Diagnosis

New lung infiltrates on chest X-ray PLUS evidence of infection

Severity Assessment

Treat as high severity if two or more of:

  • Low blood pressure (SBP≤100 mmHg)
  • High respiratory rate (≥22 breaths per min)
  • Altered mentation (Glasgow Coma Scale <15)

Required Investigations

Chest X-ray PLUS in  high severity disease:

  • Blood culture
  • Sputum culture

Viral throat swab (swab throat and nose at same time with single swab, send in viral transport medium)

Notes

Reassess daily and discuss with Microbiology if failing to respond after 48-72 hours.

Likely organisms; S. pneumonia (50% HAP), S.aureus, Coliforms, viruses, occasionally Pseudomonas spp.

If patient has been given a course of doxycycline in the past 30 days, consider alternative treatments.