Hospital Acquired Pneumonia (HAP)

NHSL Antimicrobial Guidelines
NHS Lanarkshire

Duration

Total duration (IV/Oral): 5 days

Non-Severe HAP

Therapy

Occurring > 48hrs post admission or within 10 days of discharge.
Oral Doxycycline 2, 9 100mg 12 hourly 
OR
Oral Co-trimoxazole 2,10,12,13 960mg 12 hourly

Notes:

Total duration: 5 days

Severe HAP

Therapy

Occurring > 48hrs post-admission or within 10 days of discharge.

Evidence of severe pneumonia or at risk of developing severe pneumonia.

IV Co-amoxiclav10 1.2g 8 hourly
+/- IV Gentamicin3

Stepping down to:
Oral Co-amoxiclav 625mg 8 hourly

 

Penicillin Allergy:

Oral Levofloxacin1, 2, 8, 9, 10, 12 500mg 12 hourly 
OR 
Oral / IV Co-trimoxazole2,10,12,13 960mg 12 hourly

Stepping down to:

Oral Levofloxacin1, 2, 8, 9, 10, 12 500mg 12 hourly 
OR
Oral Co-trimoxazole2,10,12,13 960mg 12 hourly

Notes:

Total Duration (IV/Oral): 5 days

Notes

Occurring > 48hrs post-admission or within 10 days of discharge

Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.

Drug Specific Cautions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
  3. Gentamicin/Vancomycin refer to online calculators.
  4. ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
  5. Monitor sodium.
  6. See CURB65 definition.
  7. Reference: The Renal Drug Handbook. Online access.
  8. See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
  9. Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
  10. Caution in renal impairment – see BNF or pharmacy for advice.
  11. Use with caution may increase K+ and decrease renal function. Monitor.
  12. High / Excellent oral bioavailability, IV route available for NBM or vomiting.
  13. See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.

Editorial Information

Last reviewed: 01/12/2022

Next review date: 01/12/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: NHS Lanarkshire Antimicrobial Management Committee

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: March 2023