GuidelinesOther guideline
Community Acquired non-S.aureus Bacteraemia Suspected Pneumonia
Infection Community acquired non-S.aureus bacteraemia SUSPECTED PNEUMONIA Brief outline/clinical setting Community acquired sepsis, suspected pneumonia as source Aetiologies/organisms S.pneumoniae, Haemophilus influenzae, Staphylococcus aureus and gram-negative bacilli (such as Klebsiella pneumoniae), Influenza virus, SARS CoV2 Optimal antimicrobial selection - Outpatient- Amoxicillin 1g 8hly PO
| Infection | Community acquired non-S.aureus bacteraemia SUSPECTED PNEUMONIA |
|---|---|
| Brief outline/clinical setting | Community acquired sepsis, suspected pneumonia as source |
| Aetiologies/organisms | S.pneumoniae, Haemophilus influenzae, Staphylococcus aureus and gram-negative bacilli (such as Klebsiella pneumoniae), Influenza virus, SARS CoV2 |
| Optimal antimicrobial selection | - Outpatient- Amoxicillin 1g 8hly PO - Inpatient non severe- Ampicillin 1-2g IVI 6hrly - Inpatient severe- cefuroxime 1.5g IVI 8hrly or Amoxicillin- clavulanate 1.2g ivi 8hrly - ≥65 years, antibiotics with 90 days or comorbidity - Amoxicillin- clavulanate 1.2g IVI 8hrly /cefuroxime 1.5g IVI 8hrly/ceftriaxone 1g IVI 12hrly ± macrolide (Azithromycin 500mg PO/IVI daily) Addition of oseltamivir during influenza peaks |
| Comments | - Patients with a CRB-65 score of 0 or a CURB-65 score of 0 or 1 are at low risk of death and may be considered for treatment at home - Patients with a CRB-65 score of 1 or 2 or a CURB-65 score of 2 are at increased risk of death, and should be referred to hospital - Patients with a CRB-65 or CURB-65 score of 3 or more are at high risk of death and require urgent hospital admission and even consideration for admission to a high-care or intensive care unit |
| Duration | Maximum 72 hrs- culture results should available in order to tailor therapy/alternative diagnosis made Total duration of therapy for CAP should be determined based on the clinical response of the patient and the causative agent. With rapid resolution of fever and clinical signs and symptoms, beta lactam therapy can be stopped after 5 days and oral therapy initiated when temperature is < 38◦, the patient can swallow and cognitively normal. Total 5 days duration for outpatients as well |
| Alternative if allergic/not available | Amoxicillin- clavulanate or cefuroxime or a third generation cephalosporin plus a macrolide |
| Rationale | Local epidemiology, local guidelines |
| Level of evidence | High |
| Link to Guideline |