Community Acquired Pneumonia - Severe

Micro-organism

Haemophilus influenza

Staphylococcus aureus

Klebsiella spp

Mycoplasma spp

First line - Neonates

Benzylpenicillin IV + Gentamicin IV for 5-7 days

Second line treatment choice on basis of culture and sensitivity - discuss with microbiology

First line - > 1month to 18 years

Amoxicillin IV for 7-14 days (Add Clarithromycin if atypical pneumonia is suspected or if no response to amoxicillin alone)

Escalate to co-amoxiclav IV +/- clarithromycin IV if not responding or had amoxicillin in preceding 14 days.

May need to extend co-amoxiclav to 14-21 days e.g if Staphylococci or gram negative bacilli suspected.

Consider IV to oral switch when afebrile > 24 hours and clinically improving.

Second line: mild intolerance or mild skin reaction

Cefotaxime +/- clarithromycin IV for 7-14 days

(Add Clarithromycin if atypical pneumonia is suspected or if no response to cefotaxime alone)

Consider IV to oral switch when afebrile > 24 hours and clinically improving.

 

Anaphylaxis (including severe skin reaction) to penicillin / cephalosporins

Vancomycin IV + Ciprofloxacin IV/PO