Hospital-Acquired Pneumonia

CONSIDER POSSIBILITY OF COVID-19 IN ALL PATIENTS WITH PNEUMONIA

Clinical features

New-onset pneumonia in a patient hospitalised for 5 days or more, or developing within 7 days of discharge

Unless severely unwell, evidence of new CXR changes should be sought before staring antibiotics

CURB-65 scoring does NOT apply

Investigations

  • Blood culture if starting IV therapy
  • Culture of expectorated sputum (NOT saliva)
  • Chest X-ray

Infection Control

Basic universal precautions

Treatment

ORAL (Not septic, and oral route available)

DOXYCYCLINE PO 200mg stat then 100mg 24 hourly

IV

AMOXICILLIN IV 1g 8 hourly 

PLUS

GENTAMICIN IV Dose as per online calculator

Do not continue Gentamicin beyond 3-4 days. If IV antibiotics are still required after this period, stop gentamicin and start Temocillin 2g 12 hourly

If true penicillin allergy:

COTRIMOXAZOLE IV 960mg 12 hourly

 If known MRSA and no penicillin allergy

TEMOCILLIN IV 2g 8 hourly 

PLUS

VANCOMYCIN IV Dose as per online calculator

Consider IV to Oral switch when clinical improvement is seen and safe to take oral medication

Duration: 5-7 days