Hospital acquired pneumonia

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Exceptions: this guidance does not cover ventilator-associated pneumonia or Wards 116 and 118 at RIE, Ward 20 at WGH and ITU at SJH. 

Diagnosis

New lung infiltrates on chest X-ray PLUS evidence of infection

Severity assessment

Treat as high severity if two or more of:

  • low blood pressure (SBP≤100 mmHg),
  • high respiratory rate (≥22 breaths per min),
  • altered mentation (Glasgow coma scale <15)

Required investigations

Chest X-ray PLUS in high severity disease:

  • Blood culture
  • Sputum culture
  • Viral throat swab (swab throat and nose at same time with single swab, send in viral transport medium)

Early onset - within 48 hours of hospital admission

Treat as community acquired pneumonia 

Late onset - more than 48 hours from hospital admission

Low severity

Recommended total duration: 5 days

Doxycycline  200mg on day one then 100mg daily orally

High severity

Recommended total duration: 5 days

Amoxicillin 1g every 8 hours IV 

PLUS

Gentamicin IV (use online NHS Lothian calculator on AMT intranet page for dosing)   

Penicillin Allergy OR Previous MRSA

Vancomycin IV (use NHS Lothian calculator on AMT intranet page)

PLUS

Gentamicin IV (use NHS Lothian calculator on AMT intranet page) 

IV to oral switch

Doxycycline 200mg on first day and then 100mg daily orally

Alternative recommendation

Co-trimoxazole 960mg every 12 hours orally

Notes

Reassess daily and discuss with Microbiology if failing to respond after 48-72 hours.

Likely organisms: S.pneumoniae (50% HAP), S.aureus, Coliforms, viruses, occasionally Pseudomonas spp.. 

If patient has been given a course of doxycycline in the past 30 days consider alternative treatments.