CAP (high severity) - CURB 65 3-5

First Line

Co-amoxiclav 1.2g IV 8 hourly 

AND

Clarithromycin 500mg PO or IV 12 hourly

(or Erythromycin 500mg 6 hourly in pregnancy)

 

If there is a previous history of MRSA - add IV vancomycin (as per protocol)

 

If there is a previous history of MRSA - add IV vancomycin (as per protocol) 

Penicillin Allergy

Levofloxacin 500mg PO or IV 12 hourly (consider safety issues)

If there is a previous history of MRSA - add IV vancomycin (as per protocol)

Levofloxacin is highly bioavailable so IV should only be used if oral route is compromised and/or concerns with GI absorption.

If levofloxacin is not preferable  e.g. seizure history, QT prolongation - IV vancomycin + gentamicin

 

Notes

Send sputum and blood cultures.

Review travel history and animal (especially birds) exposure and consider investigation for atypical pathogens.

Treatment duration -  5 days (may require longer guided by clinical response, severity of infection, pathogen isolated)