Aspiration pneumonia including pneumonia post out of hospital cardiac arrest

These guidelines apply only to Wards 116 and 118 at RIE, Ward 20 at WGH and ITU at SJH. They should not be used in any other area of NHS Lothian.

See Aspiration Pneumonia for guidance if out with critical care.

<5 days after admission to hospital

Total recommended duration: 5 days

Antimicrobial recommendation

Amoxicillin 1g every 8 hours IV

AND

Metronidazole 500mg every 8 hours IV

CONSIDER ADDING

Flucloxacillin 2g every 6 hours IV if out of hospital cardiac arrest

Penicillin allergy or previous MRSA isolated

Vancomycin IV, use Critical care continuous infusion

AND

Gentamicin IV use NHS Lothian Calculator located on AMT intranet page

AND

Metronidazole 500mg every 8 hours IV

Total recommended duration: 5 days

Antimicrobial recommendation

Piperacillin-tazobactam 4.5g every 8 hours IV (where Pseudomonas has been isolated or thought highly likely increase to every 6 hours)

CONSIDER ADDING

Vancomycin IV, use critical care continuous infusion, if previous MRSA isolated

Penicillin allergy

Vancomycin IV, use Critical care continuous infusion

AND

Gentamicin IV use NHS Lothian Calculator located on AMT intranet page

AND

Metronidazole 500mg every 8 hours IV