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)
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
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)
