Respiratory tract infections
Antimicrobial prescribing: NHS Fife
Community-acquired pneumonia
CURB-65 score can help assess severity.
Score 1 point for each of:
- New confusion (AMT ≤ 8)
- Urea > 7 mmol / L
- Resp rate ≥ 30 / minute
- BP (diastolic ≤ 60 mmHg or systolic < 90 mmHg)
- Age ≥ 65
Treatment regimens are suitable for use in patients with or without suspected or known COVID-19 infection
Treat only if there is clinical suspicion of bacterial infection, such as purulent sputum, or evidence of consolidation
CURB 65 = 0-1
ORAL
DOXYCYCLINE 200mg stat, then 100mg OD
Or
AMOXICILLIN 1g TDS
INTRAVENOUS
AMOXICILLIN 1g TDS
Duration 5 days
CURB 65 = 2
ORAL
AMOXICILLIN 1g TDS
Plus
DOXYCYCLINE 200mg stat, then 100mg OD
True penicillin allergy:
DOXYCYCLINE (monotherapy) 200mg stat, then 100mg OD
INTRAVENOUS - Seek medical advice
AMOXICILLIN 1g TDS
Plus
DOXYCYCLINE (PO) 200mg stat, then 100mg OD
True penicillin allergy:
COTRIMOXAZOLE 960mg BD (eGFR >35)
True penicillin allergy AND eGFR is <35
LEVOFLOXACIN (refer to SPC for dosing in renal impairment)
Duration: 5 days
CURB 65 = 3 or greater
No suitable initial oral treatment
Seek medical advice
INTRAVENOUS
CO-AMOXICLAV 1.2g TDS
Plus
DOXYCYCLINE 200mg stat, then 100mg OD
True penicillin allergy:
COTRIMOXAZOLE 960mg BD (eGFR >35)
True penicillin allergy AND eGFR is <35
LEVOFLOXACIN (refer to SPC for dosing in renal impairment)
Duration: 5 days
Exacerbation of COPD with clinical evidence of bacterial infection
ORAL
DOXYCYCLINE 200mg stat, then 100mg OD
Or
AMOXICILLIN 1g TDS
If clinical failure of oral therapy, send sputum and consider CO-AMOXICLAV 625mg TDS PO / 1.2g TDS IV
INTRAVENOUS
AMOXICILLIN 1g TDS
Duration 5 days
Aspiration Pneumonia
ORAL
CO-AMOXICLAV 625mg TDS
True penicillin allergy:
Discuss with Microbiology
INTRAVENOUS
CO-AMOXICLAV 1.2g TDS
True penicillin allergy:
Discuss with Microbiology
Duration: 5-7 days
Hospital or Nursing Home acquired Pneumonia
ORAL
DOXYCYCLINE 200mg stat, then 100mg OD
Or
COTRIMOXAZOLE 960mg BD (eGFR >35)
INTRAVENOUS
AMOXICILLIN 1g TDS
Plus
GENTAMICIN
Dose as per calculator
If IV treatment is still needed after three days, convert GENTAMICIN to:
TEMOCILLIN 2g TDS
True penicillin allergy:
Discuss with Microbiology
Duration 5-7 days