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 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

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.

Add STOP DATE to HEPMA

 

Notes:

Notes

Definition of HAP:  symptoms start after >48 hours in hospital or up to 48 hours after hospital discharge.  Diagnosis of HAP is difficult and often over diagnosed.

See full guidance for further information

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

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