Micro Organisms

Refer to MicroGuidance

Duration

Non severe total 5 days

Severe total IV/PO 5 days

Non Severe

Therapy

Amoxicillin oral 1g three times daily (5 days)

If true penicillin allergy oral doxycycline 200mg on day 1 then 100mg daily for 4 days  (do not co-administer with medicines containing Fe/Ca/Mg/Al/Zn, including antacids)

Add STOP DATE on HEPMA

Notes:

If NBM Amoxicillin IV Ig three times daily or if true penicillin allergy Clarithromycin IV 500mg twice daily (consider risk of prolonged QT interval and check for drug interactions)

When oral/NG route available change to oral antibiotics as per section above and add STOP DATE on HEPMA

 

Severe

Therapy

IV Amoxicillin 1g three times daily
+
IV Gentamicin (dosing as per guideline)

(If true penicillin allergy: PO/IV Co-trimoxazole + IV Gentamicin)

Step down to oral Co-trimoxazole PO 960mg twice daily to complete 5 day treatment course

Oral co-trimoxazole has very good bioavailability and should be given by oral route whenever possible.

Notes:

Notes

Routine anaerobic cover is NOT required for aspiration pneumonia.

Review IV therapy every 24 hours for IV to oral switch (see IVOST guidance)

Aspiration pneumonitis is a chemical injury that does not require antimicrobial treatment.  Reserve antibiotics for patients who fail to improve within 48 hours post aspiration.  

See full guidance for further information.

If not improving: senior review and consider other causes of clinical deterioration, including non bacterial.