ABSTRACT
Urgent hospital admission is required if the patient cannot be managed at home.
Figure 5.4: antibiotic therapy for home management of community-acquired pneumonia
St re
pt oc
oc cu
s pn
eu m
on ia
e +
+ +
– +
St ap
hy lo
co cc
us
au re
us –
– +
– +
M yc
op la
sm a
pn eu
m on
ia e
– +
- –
–
H ae
m op
hi lu
s in
flu en
za e
– +
+ –
+
A na
er ob
ic gr
am -p
os iti
ve
co cc
i +
+ +
+ +
A na
er ob
ic gr
am -n
eg at
iv e
ba ci
lli –
– –
+ +
C hl
am yd
ia –
+ –
– –
Le gi
on el
la pn
eu m
op hi
la –
+ –
– –
Fi gu
re 5
.5 :a
n ti
b io
ti c
th er
ap y
fo r
in -p
at ie
n tm
an ag
em en
to f
co m
m u
n it
yac
q u
ir ed
p n
eu m
on ia
+ effective – ineffective
Usual initial choice: augmentin or amoxycillin plus clarithromycin
Figure 5.6: antibiotic therapy for hospital-acquired pneumonia
Staphylococcus aureus Flucloxacillin or vancomycin iv
Enteric aerobic gram-negative (a) ceftazadime iv bacilli or pseudomonas aeruginosa (b) imipenem +/- aminoglycoside iv
(gentamicin) (c) aminoglycoside or beta lactam iv
Mixed flora (a) ceftazadime, metronidazole +/– aminoglycoside
(b) imipenem +/– aminoglycoside iv
Intravenous if the patient is severely ill, oral otherwise. The choice of antibiotics initially is selected on a ‘best guess’ basis until blood cultures and sputum results become available (see above, figures 5.4, 5.5 and 5.6). For most community-acquired pneumonias the choice would be a combination of clarithromycin and amoxycillin or equivalent drugs. For hospital-acquired infection, the choice of antibiotics needs to include cover of gram-negative organisms, particularly pseudomonas (ciprofloxacin would be such an antibiotic), and cover should include staphylococci in hospital-acquired pneumonia or following influenza (flucloxacillin). The antibiotics need to be given as soon as the diagnosis is made.
