Hospital Acquired Pneumonia

Important: Therapy

• 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

Important: Therapy

Use CURB65 score to assess severity and treat as for Community Acquired Pneumonia

Notes:

Consider immune deficiency and testing for HIV

Important: Therapy

Amoxicillin 1g oral 8 hourly

Important: Therapy

Doxycycline oral 100mg 12 hourly

OR

Co-trimoxazole oral 960mg 12 hourly

Important: Therapy

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

Notes:

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

Important: Therapy

Levofloxacin 500mg IV/oral 12 hourly

Notes:

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