Hospital-Acquired Pneumonia
Antimicrobial prescribing: NHS Fife
CONSIDER POSSIBILITY OF COVID-19 IN ALL PATIENTS WITH PNEUMONIA
Clinical features
New-onset pneumonia in a patient hospitalised for 5 days or more, or developing within 7 days of discharge
Unless severely unwell, evidence of new CXR changes should be sought before staring antibiotics
CURB-65 scoring does NOT apply
Investigations
- Blood culture if starting IV therapy
- Culture of expectorated sputum (NOT saliva)
- Chest X-ray
Infection Control
Basic universal precautions
Treatment
ORAL (Not septic, and oral route available)
DOXYCYCLINE PO 200mg stat then 100mg 24 hourly
IV
AMOXICILLIN IV 1g 8 hourly
PLUS
GENTAMICIN IV Dose as per online calculator
Do not continue Gentamicin beyond 3-4 days. If IV antibiotics are still required after this period, stop gentamicin and start Temocillin 2g 8 hourly
If true penicillin allergy:
COTRIMOXAZOLE IV 960mg 12 hourly
If known MRSA and no penicillin allergy
TEMOCILLIN IV 2g 8 hourly
PLUS
VANCOMYCIN IV Dose as per online calculator
Consider IV to Oral switch when clinical improvement is seen and safe to take oral medication
Duration: 5-7 days