Important: Therapy

Assess CURB65 score

• Confusion
• Urea > 7mmol/L
• Respiratory rate ≥30/min
• BP systolic <90mmHg or BP diastolic ≤60mmHg
• ≥65 years of age

Also treat as high severity if multilobar consolidation or cavitation on chest X-ray

Avoid co-amoxiclav and levofloxacin in frail elderly patients where possible due to CDI risk.

• Collect sputum (AND blood cultures in pneumonia)
• For patients with pneumonia, send urine for legionella antigen and a viral throat swab.
• Consider diagnosis of influenza and isolate patient according to Patient Placement Tool [intranet link only]
• Always consider prior therapy; patients who have not responded to a recent course of antibiotics should receive an alternative agent

Oral therapy must be considered the norm except in SEVERE pneumonia or in patients unable to take oral therapy

Consider immune deficiency and testing for HIV

Notes:

Important: Therapy

Amoxicillin oral 1g 8 hourly

OR 

Doxycycline 200mg oral stat then 100mg once daily

Notes:

Important: Therapy

Amoxicillin oral or IV 1g 8 hourly

+

Clarithromycin oral 500mg 12 hourly (until atypical excluded)

Notes:

Important: Therapy

Doxycycline monotherapy oral 100mg 12 hourly

If IV therapy required treat as high severity

Notes:

Important: Therapy

No previous antibiotics

Amoxicillin IV 1g 8 hourly

+ Clarithromycin oral 500mg 12 hourly (until atypical excluded)

Switch to oral:

Doxycycline monotherapy 100mg 12 hourly

OR

Amoxicillin 1g 8 hourly

+ Clarithromycin 500mg 12 hourly (until atypical excluded)

Previous antibiotics in community:

Co-amoxiclav* IV 1.2g 8 hourly

+ Clarithromycin 500mg oral/IV 12 hourly (until atypical excluded).

Switch to oral:

Doxycycline monotherapy 100mg 12 hourly

Notes:

*Avoid co-amoxiclav in frail elderly patients where possible due to CDI risk

If preceding influenza illness consider possibility of staphylococcal pneumonia

Risk assess for resistant organisms prior to therapy (previous microbiology sensitivities) and rationalise choice once sensitivities on current samples available

Important: Therapy

Co-trimoxazole IV 960mg 12 hourly

OR

Levofloxacin* IV 500mg 12 hourly

Switch to oral:

Doxycycline monotherapy 100mg 12 hourly

OR

Co-trimoxazole 960mg 12 hourly

Notes:

*Avoid levofloxacin in frail elderly patients where possible due to CDI risk

Levofloxacin: check important safety information in BNF & give MHRA patient information leaflet to patient

If preceding influenza illness consider possibility of staphylococcal pneumonia

Risk assess for resistant organisms prior to therapy (previous microbiology sensitivities) and rationalise choice once sensitivities on current samples available