Community Acquired Pneumonia (CAP)

Duration

Dependant on severity

CURB-65 score = 0 or 1

Therapy

Amoxicillin oral 500mg to 1g 8 hourly

Or

Doxycycline oral 200mg stat on first day then 100mg daily

Duration 5 days then review

CURB-65 score = 2

Therapy

Amoxicillin oral 500mg to 1g 8 hourly

If Legionella, Mycoplasma or other atypical bacterial pathogens suspected, add Clarithromycin oral 500mg 12 hourly

Use IV if oral route unavailable.

Switch to oral antibiotics as soon as clinically appropriate

 

If penicillin allergy,

Doxycycline oral 200mg stat on first day then 100mg daily

Or       

Clarithromycin oral 500mg 12 hourly (IV if oral route unavailable)

Duration 5 days then review.

CURB-65 score = 3 or more

Therapy

Co-amoxiclav  IV 1.2g 8 hourly

+

Clarithromycin  oral or IV 500mg 12 hourly

 

If penicillin allergy

Levofloxacin oral or IV 500mg 12 hourly

Total duration 5 days then review

Notes:

May need to be extended to 14-21 days according to clinical judgement e.g. if suspected/confirmed “atypical” pathogen, Legionella, Staphylococcal or Gram negative bacilli.

Notes

Assess CURB-65 score.

Consider sending throat swab in viral transport medium for viral studies and urine in white-topped universal for Legionella antigen.

Fluroquinolones

Refer to important safety information for all quinolones prior to prescribing.

See MHRA Drug Safety Update January 2024: Fluoroquinolones must only be used in situations when other antibiotics, that are commonly recommended for the infection, are inappropriate such as:

  • there is resistance to other first-line antibiotics recommended for the infection
  • other first-line antibiotics are contraindicated in an individual patient
  • other first-line antibiotics have caused side effects in the patient requiring treatment to be stopped
  • treatment with other first-line antibiotics has failed