Staphylococcal Pneumonia Suspected

NHSL Antimicrobial Guidelines
NHS Lanarkshire

Duration

Seek advice from Infection Specialist, if appropriate, in working hours.

Staphylococcal Pneumonia Suspected

Therapy

Consider in postinfluenza pneumonia, cavitating pneumonia in patients with Staphylococcal soft tissue infection, or cavitating pneumonia in PWID with right-sided endocarditis.

CURB65 score6: 3-5 or SEPSIS

IV Amoxicillin 1g 8 hourly 
+ IV Flucloxacillin5 1g 6 hourly

OR
If previously treated or adverse prognostic features:

IV Co-amoxiclav10 1.2g 8 hourly 
+ IV Flucloxacillin5 1g 6 hourly

 

Stepping down to:
Seek advice from Infection Specialist, if appropriate, in working hours.

 

Penicillin Allergy OR MRSA Suspected
Oral Levofloxacin1, 2, 8, 9, 10, 12 500mg 12 hourly
+ IV Vancomycin3

Stepping down to:
Seek advice from Infection Specialist, if appropriate, in working hours.

Notes:

Total Duration: Seek advice from Infection Specialist, if appropriate, in working hours.

Notes

Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.

Drug Specific Cautions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
  3. Gentamicin/Vancomycin refer to online calculators.
  4. ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
  5. Monitor sodium.
  6. See CURB65 definition.
  7. Reference: The Renal Drug Handbook. Online access.
  8. See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
  9. Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
  10. Caution in renal impairment – see BNF or pharmacy for advice.
  11. Use with caution may increase K+ and decrease renal function. Monitor.
  12. High / Excellent oral bioavailability, IV route available for NBM or vomiting.
  13. See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.

Editorial Information

Last reviewed: 01/12/2022

Next review date: 01/12/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: NHS Lanarkshire Antimicrobial Management Committee

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: March 2023