Community-acquired pneumonia (CAP)

Mild Community-acquired pneumonia (CAP) or pneumonia within 48 hours of admission

Oral therapy is safe and effective in mild CAP.  Intravenous amoxicillin or clarithromycin therapy is only indicated in those who cannot tolerate oral medication.

Amoxicillin oral*

If true penicillin allergy:

Clarithromycin oral

*Note: consider adding clarithromycin if mycoplasma pneumonia suspected

Severe CAP, or presenting also with influenza

Co-amoxiclav IV

Duration: Uncomplicated pneumonia; 7 days

For advice regarding antivirals in influenza, refer to HPS guidance:

Hospital-acquired pneumonia (HAP)

Pneumonia with onset > 48h after admission

Review risk of MRSA infection and available microbiology/virology results, Seek advice

TreatmentCefotaxime IV

Community aspiration pneumonia

On admission or up to 48h after admission

Treatment

Co-amoxiclav IV

If true penicillin allergy:

Cefotaxime IV

Plus

Metronidazole IV

Hospital aspiration pneumonia

Over 48h after admission

Review risk of MRSA infection and available microbiology/virology results and seek advice

Treatment

Cefotaxime IV

Plus

Metronidazole IV

Bronchiectasis - acute exacerbation

Review most recent culture and sensitivity results as this may guide treatment choice.

If in doubt seek specialist respiratory advice
Empiric Treatment

Co-amoxiclav PO or IV

If true penicillin allergy:

Seek Microbiology advice

Duration: 10 to 14 days

Cystic fibrosis

Refer to Scottish Paediatric CF MCN prescribing guidelines.

Other Respiratory Tract Infections

Whooping cough

Clarithromycin oral or IV

Treat for 7 days

If clinically suspected take NPA in children under 2 years old or a throat swab in older children (both in viral transport medium for PCR).

This is a reportable disease and during working hours contact Public Health Medicine who will review the need for prophylaxis in contacts.

Varicella pneumonitis

Aciclovir IV (high dose)

Treat for minimum 7 days

Patients should be adequately hydrated during high dose aciclovir therapy. Ensure urine output is at least 1 ml/kg/hr.

Pneumocystis jiroveci pneumonia

Co-trimoxazole IV (high dose)

Seek specialist advice

Treat for minimum 14 days. If immunocompromised, treat for 21 days.