Community Acquired Pneumonia

Treatment in the Community (Adults)

  • Avoid tetracyclines in pregnancy.
  • Low doses of penicillins are more likely to select out resistance.
  • The quinolones ciprofloxacin and ofloxacin have poor activity against pneumococci. However, they do have use in PROVEN pseudomonal infections. Moxifloxacin and Levofloxacin has some anti-Gram-positive activity but should not be needed as first line treatment

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority website for drug SPCs, dosage, contraindications, interactions, or IMF/BNF/BNFC/MIMS. See guidance on dosing in children for quick reference dosage/weight guide. Letters indicate strength of evidence range from A+ (systematic review) to D (informal opinion). Statins can interact with some antibiotics and increase the risk of rhabdomyolysis. Amiodarone and drugs which prolong the QT interval can interact with many antibiotics. Many antibiotics increase the risk of bleeding with anticoagulants. Please refer to our Drug Interactions Table for further information.

Comments

Start antibiotics immediately.B- 

Assess using the CRB-65 score (Confusion, Respiratory rate ≥ 30/min, BP ≤90/60, Age ≥ 65)
Score 0: suitable for home treatment;
Score 1-2: consider hospital referral;
Score 3-4: urgent hospital admission.
Add macrolide if CRB-65=1 and suitable for home treatment (HPA guidance).

If no response in 48 hours consider admission or add a macrolide first line or a tetracycline C to cover Mycoplasma infection (rare in over 65s).

In severely ill patients, give parenteral benzylpenicillin before admissionand seek risk factors for Legionella and Staph. aureus infection. D

Treatment

Treatment Dose TX Duration
amoxicillin 500 mg - 1g TDS Up to 10 days
clarithromycin 500 mg BD Up to 10 days
OR doxycycline 200 mg stat/100 mg OD Up to 10 days

See guidance on dosing in children for quick reference dosage/weight guide.

Patient Information

The HSE Health A-Z website provides patient information on many hundreds of conditions and treatments.

We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

Reviewed June 2016


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