Hospital acquired Pneumonia (excluding Critical Care)

Definition of Hospital-acquired Infection

  • Onset of infection 48 hours or more after hospital admission

    OR
  • 
  • Infection present on admission but patient is within 10 days of previous in-patient stay
  • Clinical diagnosis: A new / progressive infiltrate on chest X-ray plus 2 or more of the following clinical features represent the most accurate clinical criteria for starting empiric antibiotic therapy:

                - Temperature <36.0°C or >38.0°C
                - Leucocytosis (>12x109/L) or leucopenia (<4 x109/L)
                - Purulent respiratory secretions 

Severity
(classification)

 

1st line oral/iv antibiotics

 

Penicillin allergy

(see explanatory notes)

A/B

Minor to
severe infection

Review doses in renal impairment

CO-AMOXICLAV 625mg po tds

Typical duration: 7 days

LEVOFLOXACIN 500mg po bd
(Consider reducing to 500mg od if patient clearly improving)

Typical duration: 7 days

C

Severe life threatening infection

 

Review doses in renal impairment

 

Send urine sample to microbiology for pneumococcal/legionella antigen tests

Age less than 65 years

CEFTRIAXONE 2g iv od

 If suspected MRSA, ADD:

VANCOMYCIN iv (as per local policy)

Age 65 years or older

*LEVOFLOXACIN 500mg po/iv bd
(Oral route preferred. Consider reducing to 500mg od if patient clearly improving)

plus

VANCOMYCIN iv (as per local policy)


*NOTE:
if iv levofloxacin is required and there is no stock available, please switch the levofloxacin to:
CIPROFLOXACIN 400mg iv bd

For aspiration pneumonia click here

If unresponsive to treatment or previously treated with antibiotics above discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist

REVIEW THERAPY with culture results at 48-72 hours. If initial diagnosis of hospital acquired pneumonia is in doubt (i.e. absence of clinical features above) and cultures are negative then consider stopping antibiotics.

 

 


 

Send urine sample to microbiology for pneumococcal/legionella antigen tests

 *LEVOFLOXACIN 500mg po/iv bd
(Oral route preferred. Consider reducing to 500mg od if patient clearly improving)

plus

VANCOMYCIN iv (as per local policy)

*NOTE: if iv levofloxacin is required and there is no stock available, please switch the levofloxacin to: CIPROFLOXACIN 400mg iv bd

For aspiration pneumonia click here

  • If unresponsive to treatment or previously treated with antibiotics above discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist

REVIEW THERAPY with culture results at 48-72 hours. If initial diagnosis of hospital acquired pneumonia is in doubt (i.e. absence of clinical features above) and cultures are negative then consider stopping antibiotics.

 

IV to Oral Switch

(explanatory notes)

CO-AMOXICLAV 625mg po tds

LEVOFLOXACIN 500mg po bd

(Consider reducing to 500mg od if patient clearly improving)

 

Typical duration of therapy for hospital acquired pneumonia is 7 days.

Last Reviewed: 09/05/17

For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)