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

TAZOCIN 4.5g iv tds (monotherapy)

 

  • If suspected MRSA, ADD:

VANCOMYCIN 1g iv bd

(If CrCl <50, reduce dose as per renal dosing guidance

Note that the antibiotic regimens above provide adequate cover for aspiration pneumonia occurring in hospital

 

  • 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 1g iv bd

(If CrCl <50, reduce dose as per renal dosing guidance

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: 16/09/15

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