Duration

Suspected Atypical Pneumonia (IV/Oral): 5 days.

Confirmed Legionella Pneumonia (IV/Oral): minimum 7 days; longer duration may be required in severe disease or immunocompromised.

Suspected Atypical Pneumonia

Therapy

If Atypical Pneumonia suspected, add Macrolide to recommended Community Acquired pneumonia therapy: 

IV Amoxicillin 1g 8 hourlyORIf previously treated or adverse prognostic features: IV Co-amoxiclav10 1.2g 8 hourlyPLUSORAL Clarithromycin1 500mg 12 hourly(If pregnant ORAL Erythromycin1 500mg 6 hourly)

 

Penicillin Allergy 
Oral Doxycycline2, 9 200mg stat then 100mg daily
OR 
Oral Levofloxacin1, 2, 8, 9, 10, 12 500mg 12 hourly.

Doxycycline & Levofloxacin also cover atypical pneumonia organisms so Macrolide not required. 

Risk factors Include: 

  • Returning travellers 
  • Bird or animal exposure

Notes:

Total Duration (IV/Oral): 5 days.

Confirmed Legionella Pneumonia

Therapy

Oral Levofloxacin1,2,8,9,10,12 500mg 12 hourly.

Notes:

Total duration (IV/oral) minimum 7 days; longer duration may be required in severe disease or immunocompromised.

Notes

Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.

Drug Specific Cautions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
  3. Gentamicin/Vancomycin refer to online calculators.
  4. ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
  5. Monitor sodium.
  6. See CURB65 definition.
  7. Reference: The Renal Drug Handbook. Online access.
  8. See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
  9. Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
  10. Caution in renal impairment – see BNF or pharmacy for advice.
  11. Use with caution may increase K+ and decrease renal function. Monitor.
  12. High / Excellent oral bioavailability, IV route available for NBM or vomiting.
  13. See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.

Editorial Information

Last reviewed: 01/12/2022

Next review date: 01/12/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: NHS Lanarkshire Antimicrobial Management Committee

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: March 2023