Therapeutic Handbook - GGC Prescribing

Pneumonia (continued from previous page)Pneumonia Antibiotic Therapy Notes / CommentsSuspected Staphylococcusaureus pneumonia (postinfluenza, or chicken pox orsevere bilateral / cavitatorychanges)Suspected aspirationpneumoniaTreat as per severe CAP(page 233) and add in:Flucloxacillin IV 2 g 6 hourlyIf true penicillin / beta-lactamallergy or MRSA suspected:Vancomycin IV (dosing infopage 266)andClarithromycin* IV 500 mg12 hourlyTotal course duration 10 days(IV and oral)Metronidazole IV 500 mg8 hourlyWith either:Amoxicillin IV 1 g 8 hourlyorClarithromycin* IV 500 mg12 hourlyTotal course duration (IV andoral) 7 days.Staphylococcus aureuspneumonia is severeand life-threatening andrequires admission to highdependency / ITU.Discuss further managementwith microbiology / infectiousdiseases consultant andrespiratory physicians.*Clarithromycin – seriousdrug interactions (seeBNF Appendix 1) and QTcprolongation.Consider aspiration pneumoniaif:- history of impairedswallowing or- vomiting with possibleaspiration 48 hoursbefore.Infection is indicated bychange in sputum quality topurulent or mucopurulent orfever and new chest x-raychanges.Aspiration pneumonitis doesnot require antimicrobialtherapy.*Clarithromycin – seriousdrug interactions (seeBNF Appendix 1) and QTcprolongation.InfectionsPage 235