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Antibiotic Formulary Prescribing Advice Adult V6.4 Printed copies are not controlled and are valid on date of printing only. This version was last printed: 16 Apr. 12 Lower Respiratory Tract Infections Inc. COPD, Pneumonia, TB
4.3.1 Bronchitis, Acute

4.3.2 Bronchitis, Chronic And COPD, Acute Exacerbations Of
Doxycycline 200mg loading dose then 100mg od po
Amoxicillin 500mg po every 8 hours
Clarithromycin 500mg po every 12 hours
4.3.3 Pneumonia

Introduction

Specimens: fresh sputum and blood for culture; blood for serology should be collected at onset of
disease, and two weeks later.
If patient apyrexial for at least 24 hours you may change the route to oral.
The following advice has been adapted from the current British Thoracic Society Guidelines on the
management of community-acquired pneumonia in adults admitted to hospital.
4.3.4 Community Acquired Pneumonia

CURB-65 (British Thoracic Society)
NOTE: Clinical or X-ray evidence of lobar consolidation required.

Score 1 for each
acute unexplained Confusion (mental test score <8, or disorientation in time/place/person)
Urea > 7mmol/l
Respiratory rate 30/min
Blood pressure - systolic <90 mmHg and/or diastolic 60 mmHg

THE CURB-65 SCORE IS NOT A SUBSTITUTE FOR GOOD CLINICAL JUDGEMENT

Mild Pneumonia (CURB Score 0-1)
First Line:
Amoxicillin 500mg-1g po every 8 hours
Second Line (Beta-lactam allergy): Doxycycline 200mg loading dose then 100mg po
Clarithromycin 500 mg po 12 hourly
BEFORE PRESCRIBING ANY ANTIMICROBIAL, CHECK FOR ALLERGIES, DRUG
INTERACTIONS & CONTRAINDICATIONS
Antibiotic Formulary Prescribing Advice Adult V6.4 Printed copies are not controlled and are valid on date of printing only. This version was last printed: 16 Apr. 12

Moderate Pneumonia (CURB Score 2)
First Line:
Amoxicillin 500mg-1g po every 8 hours plus
clarithromycin 500mg po every 12 hours
Second Line (Beta-lactam allergy): Doxycycline 200mg loading dose, then 100mg po once daily

Severe Pneumonia (CURB Score ≥3 or Pa O2 <8 KPa or Sa O2 <92% on any Fi O2)
Duration of therapy is usually 7 to 10 days but contact microbiology if no significant response to
therapy after 72 hours.
First Line:
Co-amoxiclav 1.2g iv every 8 hours plus clarithromycin
500mg iv or po every 12 hours. Contact microbiologist if
suspicion of PVL or other unusual organism. Consider early
oral switch for clarithromycin.

If penicillin allergy but can tolerate cefuroxime: cefuroxime
1.5g iv every 8 hours plus clarithromycin 500mg iv every
12 hours. Consider early oral switch for clarithromycin.


NOTE: Clarithromycin is aimed at atypical organisms and its concomitant use with a Beta-lactam
carries a significant Clostridium difficile risk. Furthermore it may act to antagonise the action of the
Beta-lactam antibiotic. ENSURE THE MACROLIDE IS REALLY NECESSARY! Clarithromycin should
be stopped once atypical pneumonia is excluded


Atypical Pneumonia

Treatment must be directed at the causative agent and may need to be prolonged. Consider
underlying disease processes (e.g. need for HIV test).
If there are problems with antibiotic allergy, and/or concerns about the response to the above
antibiotics, please contact the duty microbiologist for your site.
BEFORE PRESCRIBING ANY ANTIMICROBIAL, CHECK FOR ALLERGIES, DRUG
INTERACTIONS & CONTRAINDICATIONS
Antibiotic Formulary Prescribing Advice Adult V6.4 Printed copies are not controlled and are valid on date of printing only. This version was last printed: 16 Apr. 12 4.3.5 Hospital-Acquired Pneumonia

Early onset (<5 days admission):
Mild
First Line:
Amoxicillin 500mg-1g po every 8 hours
Second Line (Beta-lactam allergy): Doxycycline 200mg loading dose then 100mg po
Co-amoxiclav 1.2g iv every 8 hours. Review daily
with a view to early iv to oral switch.
Second Line (Minor penicillin rash): Cefuroxime 1.5g iv every 8 hours.
(Severe Beta-lactam allergy/MRSA risk):

Late onset (>5 days admission) or severe:
First Line:
Piperacillin/tazobactam 4.5g iv every 8 hours
Second Line (Minor penicillin rash): Meropenem 1g iv every 8 hours
Discuss with Consultant Microbiologist (Severe Beta-lactam allergy/MRSA risk): 4.3.6 Pneumonia, Aspiration Of Vomit Known Or Suspected

NB This is not appropriate for aspiration in the absence of pneumonia.
First Line:
Co-amoxiclav 1.2grams iv every 8 hours
5 days. Consider oral therapy if patient's condition permits. Second Line (Minor penicillin rash): Cefuroxime 1.5g iv every 8 hours plus
metronidazole 500mg iv every 8 hours
(Severe beta-lactam allergy/MRSA risk): BEFORE PRESCRIBING ANY ANTIMICROBIAL, CHECK FOR ALLERGIES, DRUG
INTERACTIONS & CONTRAINDICATIONS

Source: http://www.ulh.nhs.uk/for_staff/education_and_training/applications/medical_induction/main%20menu/media/232.pdf