Micro Organisms

Refer to MicroGuidance

Duration

Mild/Moderate disease 5 days 

Severe disease 5 days

Mild/Moderate (CURB65-0-2)

Therapy

Amoxicillin oral 1g three times daily (5 days)
or
if true penicillin allergy oral Doxycycline 200mg on day 1 then 100mg once 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 1g 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 (CURB65 3-5)

Therapy

Co-amoxiclav IV 1.2g three times daily

+

Doxycycline 100mg twice daily (do not co-administer with medicines containing Fe/Ca/Mg/Al/Zn, including antacids)

If true penicillin allergy Levofloxacin IV 500mg twice daily monotherapy (review quinolone warnings, consider risk of QT interval and check for drug interactions)

Step down to doxycycline 100mg twice daily for all severe CAP to complete 5 days treatment

When on oral therapy add STOP DATE to HEPMA

Notes:

If NBM Co-amoxiclav 1.2g three times daily PLUS Clarithromycin IV 500mg twice daily (consider risk of prolonged QT interval and check for drug interactions)

When oral/NG route available change to doxycycline 100mg twice daily - add STOP DATE on HEPMA and do not co-administer with medicines containing Fe/Ca/Mg/Al/Zn, including antacids

ICU/HDU

Therapy

Co-amoxiclav IV 1.2g three times daily

+

Clarithromycin IV 500mg twice daily (consider risk of prolonged QT interval and check for drug interactions)

If penicillin allergy IV levofloxacin 500mg twice daily monotherapy (review quinolone warnings, consider risk of QT interval and check for drug interactions)

Step down to doxycycline 100mg twice daily for all severe CAP (do not co-administer with medicines containing Fe/Ca/Mg/Al/Zn, including antacids)

When on oral therapy add STOP DATE on HEPMA

Notes:

Notes

Assess CURB65 score

See full guidance for further information

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

If not improving:  repeat CXR (empyema), sputum culture consider investigations for mycobacterial species including TB.  Discuss with Respiratory team. 

HIV testing:  Any patient with recurrent CAP (≥2 episodes in 12 months) but also consider in other CAP patients.