Influenza-related Pneumonia

  • Antiviral therapy, oseltamivir (Tamiflu®) or zanamivir (Relenza®) typically to complete 5 days
  • Public Health England: influenza guideline

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A
Minor to moderate infection

Review doses in renal impairment

DOXYCYCLINE 200mg po od
OR, if prior treatment with doxycycline, use:
CO-AMOXICLAV 625mg po tds

Treatment duration: typically 7 days

DOXYCYCLINE 200mg po od
OR, if prior treatment with doxycycline, use:
CLARITHROMYCIN 500mg po bd

Treatment duration: typically 7 days

 B 

Moderate to severe infection

Review doses in renal impairment

 

 

 

 

 

 

CO-AMOXICLAV 1.2g iv tds (or co-amoxiclav 625mg po tds, depending on severity assessment)

plus

CLARITHROMYCIN 500mg po/iv bd
(oral route preferred)

If suspected MRSA, ADD:
VANCOMYCIN 1g iv bd

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

Total treatment duration (including oral step-down): typically 7-14 days

 

*LEVOFLOXACIN 500mg po/iv bd
(Oral route preferred. Consider reducing to 500mg od if patient clearly improving)
 
If suspected MRSA, ADD:
VANCOMYCIN 1g iv bd 

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

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

Total treatment duration (including oral step-down): typically 7-14 days

 C

 

Severe life threatening infection

Review doses in renal impairment

CO-AMOXICLAV 1.2g  iv tds

plus

CLARITHROMYCIN 500mg po/iv bd
(oral route preferred)

If suspected MRSA, ADD:

VANCOMYCIN 1g iv bd 

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

Total treatment duration (including oral step-down): typically 7-14 days

*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

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

Total treatment duration (including oral step-down): typically 7-14 days

IV to Oral Switch

(explanatory notes)

CO-AMOXICLAV 625mg po tds
plus

CLARITHROMYCIN 500mg po bd

LEVOFLOXACIN 500mg po bd

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

If MRSA positive: Discuss with microbiologist if severe infection
Total antibiotic duration typically 7-14 days

Last Reviewed: 09/05/17

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