Community-acquired LRTI/Pneumonia (community onset without hospital admission ≥5 days in previous 4 weeks)

First Line

Important: Therapy

i) Amoxicillin 500mg-1g PO 8 hourly

 

ii) Doxycycline 200mg PO STAT then 100mg daily

Notes:

If oral route compromised:

Ceftriaxone 2g IV 24 hourly

Second Line

Important: Therapy

Try different first line agent initially if persistent signs of infection but haemodynamically stable

or if felt deteriorating infection but not severe:

Co-trimoxazole 960mg PO/IV 12 hourly 

Notes:

Severe Infection

Important: Therapy

Ceftriaxone 2g IV 24 hourly

or if severe penicillin allergy:

Levofloxacin 500mg PO/IV 12 hourly (consider safety issues)

 

Notes:

Essential to confirm CrCl in this patient group: if CrCl <50ml/min maximum dose of levofloxacin 250mg PO/IV 12 hourly 

Important: Notes

NB -BTS Definition of Pneumonia

Cough and at least one other lower respiratory tract symptom AND new focal chest signs on examination AND EITHER sweating, fevers, shivers, aches and pains OR fever > 38°C AND no other explanation for symptoms

Treatment duration - 5 days (Severe infection may require longer e.g 7-10 days guided by clinical response.