Initial Antibiotic Therapy of Hospital-Acquired Pneumonia (HAP)

Initial Antibiotic Therapy of Hospital-Acquired Pneumonia (HAP)

	Initial antibiotic therapy
Severity of HAP	No penicillin allergy	Penicillin allergy
Non-severe	Co-amoxiclav 1.2g 8-hourly IV for 5–10 days^*	Clarithroymycin 500 mg 12-hourly IV/PO for 5–10 days
Severe^†	Tazocin 4.5g 8-hourly IV + gentamicin for 5–10 days or Ceftazidime 1g 8-hourly IV + gentamicin (+ vancomycin if MRSA is suspected)	Meropenem 0.5–1g 8-hourly IV + gentamicin or Levofloxacin 500 mg 12-hourly IV

Initial antibiotic therapy

Severity of HAP

No penicillin allergy

Penicillin allergy

Non-severe

Co-amoxiclav 1.2g 8-hourly IV for 5–10 days^*

Clarithroymycin 500 mg 12-hourly IV/PO for 5–10 days

Severe^†

Tazocin 4.5g 8-hourly IV + gentamicin for 5–10 days

Ceftazidime 1g 8-hourly IV + gentamicin (+ vancomycin if MRSA is suspected)

Meropenem 0.5–1g 8-hourly IV + gentamicin

Levofloxacin 500 mg 12-hourly IV

^*Consider switching to oral therapy after 48h if there is clinical improvement and plasma C-reactive protein level is falling.

^†Treat as severe HAP if any of the following are present: rapidly progressive consolidation on chest X-ray; respiratory rate >30, PaO₂<8kPa, high oxygen requirement; shock (systolic BP <90 mmHg or diastolic BP <60 mmHg); admitted to high dependency unit or intubated and ventilated.

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Table 63.1