Canterbury DHB

Context

Community-acquired Pneumonia

Pathogens

Drug Treatment

In This Section

Empiric

Pathogens Known

Empiric

Mild Disease (CURB-65 0-1)

amoxicillin

HMLSchedNZFPMLnoids

PO 1000 mg three times a day

If risk factors for Legionella species, add:

azithromycin

HMLSchedNZFPML

PO 500 mg once a day

Mild penicillin allergy

cefalexin

HMLSchedNZFPML

PO 1000 mg three times day

If risk factors for Legionella species, add:

azithromycin

HMLSchedNZFPML

PO 500 mg once a day

Severe penicillin allergy

Consult Infectious Diseases/Clinical Microbiology.

Moderate Disease (CURB-65 2)

amoxicillin

HMLSchedNZFPMLnoids

IV 1 g every eight hours

then PO 1000 mg three times a day

AND

azithromycin

HMLSchedNZFPML

PO 500 mg once a day

Mild penicillin allergy

cefuroxime

HMLSchedNZFPMLnoids

IV 1.5 g every eight hours

then PO 500 mg twice a day

AND

azithromycin

HMLSchedNZFPML

PO 500 mg once a day

Severe penicillin allergy

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines (use high doses).

AND

azithromycin

HMLSchedNZFPML

PO 500 mg once a day

Severe Disease (CURB-65 3-4)

amoxicillin+clavulanic acid

HMLSchedNZFPMLnoids

IV 1 g/200 mg every eight hours

then PO 500 mg/125 mg three times a day

AND EITHER

azithromycin

HMLSchedNZFPML

PO 500 mg once a day

OR

clarithromycin

HMLSchedNZFPMLnoids

IV 500 mg every twelve hours (for 1 or 2 doses then change to azithromycin PO 500 mg once a day)

Mild penicillin allergy

cefuroxime

HMLSchedNZFPMLnoids

IV 1.5 g every eight hours

then PO 500 mg twice a day

AND EITHER

azithromycin

HMLSchedNZFPML

PO 500 mg once a day

OR

clarithromycin

HMLSchedNZFPMLnoids

IV 500 mg every twelve hours (for 1 or 2 doses then change to azithromycin PO 500 mg once a day)

Severe penicillin allergy or any cephalosporin allergy

Consult Infectious Diseases/Clinical Microbiology.

Extremely Severe Disease (CURB-65 5)

amoxicillin+clavulanic acid

HMLSchedNZFPMLnoids

IV 1 g/200 mg every eight hours

then PO 500 mg/125 mg three times a day

AND

ciprofloxacin

HMLSchedNZFPMLnoids

IV 400 mg every twelve hours

If immunosuppressed, or pre-existing lung disease with increased risk of Pseudomonas species infection:

piperacillin+tazobactam

HMLNZFPMLnoids

IV 4 g/500 mg every eight hours

AND

ciprofloxacin

HMLSchedNZFPMLnoids

IV 400 mg every twelve hours

Mild penicillin allergy

Consult Infectious Diseases/Clinical Microbiology.

Severe penicillin allergy

Consult Infectious Diseases/Clinical Microbiology.

Pathogens Known

Most patients should be on oral therapy.

If severe/extremely severe, administer antimicrobials IV except for azithromycin (if stable and able to swallow).

Streptococcus pneumoniae

Amoxicillin susceptible: see CURB-65 2 disease empiric treatment, increasing amoxicillin dosing frequency to every six hours if the MIC is 2 mg/L.

Reduced amoxicillin susceptibility: MIC > 2 mg/L

Consult Infectious Diseases/Clinical Microbiology.

Haemophilus influenzae, Moraxella catarrhalis

amoxicillin

HMLSchedNZFPMLnoids

PO 500 mg three times a day

If beta-lactamase producing:

amoxicillin+clavulanic acid

HMLSchedNZFPMLnoids

PO 500 mg/125 mg three times a day

Mild penicillin allergy

cefuroxime

HMLSchedNZFPMLnoids

PO 500 mg twice a day

Severe penicillin allergy

Consult Infectious Diseases/Clinical Microbiology.

Staphylococcus aureus

Start antimicrobial therapy as below, and consult with Infectious Diseases/Clinical Microbiology.

flucloxacillin

HMLSchedNZFPMLnoids

IV 2 g every six hours

Mild penicillin allergy

cefazolin

HMLSchedNZFPMLnoids

IV 2 g every eight hours

Patients with severe penicillin allergy or MRSA, consult with Infectious Diseases/Clinical Microbiology and consider:

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines (use high doses).

Klebsiella pneumoniae

ceftriaxone

HMLSchedNZFPMLnoids

IV 2 g every 24 hours

Severe penicillin allergy

Consult Infectious Diseases/Clinical Microbiology.

Mycoplasma pneumoniae

Mild or moderate disease

doxycycline

HMLSchedNZFPML

PO 100 mg twice a day for 7 to 10 days

OR

azithromycin

HMLSchedNZFPML

PO 500 mg once a day for 5 to 7 days

Severe disease

Consult Infectious Diseases/Clinical Microbiology/Respiratory Medicine.

Legionella species (notifiable)

azithromycin

HMLSchedNZFPML

PO 500 mg once a day for 5 to 7 days

Information about this Canterbury DHB document (99246):

Document Owner:

Not assigned (see Who's Who)

Last Updated:

May 2019 (Respiratory System)

Next Review Due:

May 2022

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.

Topic Code: 99246