Hospital Acquired Pneumonia
Duration
Non-severe: 5 days
Severe: 7 - 10 days
- Collect sputum (AND blood cultures in pneumonia)
- For patients with pneumonia, send urine for legionella antigen and a viral throat swab.
- Consider diagnosis of influenza and isolate patient according to Patient Placement Tool [intranet only]
- Always consider prior therapy; patients who have not responded to a recent course of antibiotics should receive an alternative agent
Oral therapy must be considered the norm except in SEVERE pneumonia or in patients unable to take oral therapy
Use CURB65 score to assess severity and treat as for Community Acquired Pneumonia
Consider immune deficiency and testing for HIV
Amoxicillin 1g oral 8 hourly
Doxycycline oral 100mg 12 hourly
OR
Co-trimoxazole oral 960mg 12 hourly
IV Co-amoxiclav 1.2g 8 hourly
If life-threatening,
+ IV Gentamicin¥ (Hartford Regimen) as per guideline
Use preferred calculator on Hospital portals page [intranet access only] or calculator on app
Switch to oral:
Co-amoxiclav 625mg 8 hourly
If MRSA likely, add IV Vancomycin as per guideline
Use preferred calculator on Hospital portals page [intranet access only] or calculator on app for intermittent dosing
¥If >72 hours IV therapy required replace gentamicin with temocillin IV 2g 12 hourly
Levofloxacin 500mg IV/oral 12 hourly
If MRSA likely, add IV Vancomycin as per guideline
Use preferred calculator on Hospital portals page [intranet access only] or calculator on app for intermittent dosing
Levofloxacin: check important safety information in BNF & give MHRA patient information leaflet to patient