Community-acquired LRTI/Pneumonia (community onset without hospital admission ≥5 days in previous 4 weeks)

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

First Line

Therapy

i) Amoxicillin 500mg-1g PO 8 hourly

 

ii) Doxycycline 200mg PO STAT then 100mg daily

 

iii) Clarithromycin 500mg PO 12 hourly

Notes:

If oral route compromised:

Ceftriaxone 2g IV 24 hourly (administered as per local SOP)

Second Line

Therapy

Try different first line agent initially if persistent signs of infection but haemodynamically stable

or if felt deteriorating infection but not severe:

Co-trimoxazole 960mg PO 12 hourly 

(see BNF for dosing advice of co-trimoxazole in patients with renal impairment [<30 ml/min])

Notes:

Severe Infection

Therapy

Ceftriaxone 2g IV 24 hourly

or

Levofloxacin 500mg PO/IV 12 hourly (consider safety issues and dose adjustment if CrCl <50)

 

Notes:

Notes

NB -BTS Definition of Pneumonia

Cough and at least one other lower respiratory tract symptom AND new focal chest signs on examination AND EITHER sweating, fevers, shivers, aches and pains OR fever > 38°C AND no other explanation for symptoms

Treatment duration - 5 days (Severe infection may require longer e.g 7-10 days guided by clinical response.