Pneumonia treatment - Quick reference guide

*Refer to the on-line WUTH Antibiotic Formulary for alternative treatment in case of allergy, history
of MRSA, dosing in renal disease and for antibiotic course length.
SMOKING
CESSATION
ADVICE
If a smoker within
the last 12 months,
offer support, NRT
and referral to
services
(document in
notes)




Community
Acquired
Pneumonia
Hospital
Acquired
Pneumonia /
Residential Home
Patients Give
antibiotic
ASAP
CURB-65 Score
(score 1 point for each)

Confusion
Urea >7mmol/L
Respiratory Rate >30/min
BP Systolic<90mmHg
Diastolic<60mmHg
Age >65years
CURB-65 score = 0 to1
Amoxicillin 500mg po tds
Penicillin allergy:
Doxycycline 200mg po stat
then 100mg po od

CURB-65 score = 2
Amoxicillin 500mg po tds
PLUS Clarithromycin 500mg
po every 12 hours*
Penicillin allergy:
Doxycycline 200mg po stat
then 100mg po od

CURB-65 score 3
Co-amoxiclav 1.2g IV tds*
PLUS Clarithromycin 500mg po/IV bd*
Penicillin allergy:
Levofloxacin 500mg po/IV bd*
PLUS Vancomycin IV individualised dose*
Community Acquired
Pneumonia Regime 4:
For patients who have had a hospital
admission within the previous 10 days,
patients admitted from a nursing home
and patients who frequently attend
a hospital for treatment
Piperacillin with Tazobactam
4.5g IV tds *
PLUS Clarithromycin
500mg po/IV bd*
MRSA, ADD Vancomycin IV *
Penicillin allergy
Levofloxacin
500mg po bd *
PLUS Vancomycin IV *
Consider treating as higher
CURB score if additional
features of severity are
present / the patients
presentation is clinically
severe always document
Hypoxaemia (PaO
2
8kPa)
CXR: bilateral consolidation or
>2 lobe involvement
Respiratory Failure
Early Onset
Hospital Acquired Pneumonia
(>48 hours to <5 days after admission)
(includes aspiration cover)
Co-amoxiclav 1.2g IV tds *
Penicillin allergy
Levofloxacin 500mg po bd *
If concern over aspiration give
Levofloxacin IV* and
ADD Metronidazole 500mg IV bd *
Late Onset
Hospital Acquired Pneumonia
(>5 days since admission)
(includes aspiration cover)
Piperacillin with Tazobactam
4.5g IV tds*
Penicillin allergy
Levofloxacin 500mg po bd*
If concern over aspiration give
Levofloxacin IV and
ADD Metronidazole 500mg IV bd*
OXYGEN
ASSESSMENT &
PRESCRIPTION
Pneumonia treatment - Quick Reference Guide, v1. Authors: AQ Focus Group
Approved by Medicines Clinical Guidance Team: Jan 2014 Review by: Jan 2017
BLOOD
CULTURES
if chest sepsis
suspected / indicated
APPROPRIATE
ANTIBIOTICS
(within 6 hours of
arrival to hospital)
EARLY CXR
& DIAGNOSIS
Conjunctive
Management
Suspected
Chest Infection
on history
or examination
plus new radiographic changes