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LWI 1.2 Community-acquired pneumonia (CAP) - unknown pathogen - moderately severe (AMBU-65 2)

Content version
U-255.2
Updated
10/20/2025 - 14:57

Recommendations

≥ 18 years
Dosage Remarks
1st choice
benzylpenicillin IV 1 million IU 4 times daily for 3 days

- If the patient does not clinically improve and does not meet clinical stability criteria* on day 3, extend the total antibiotic duration to 5 days.

- If the patient is immunocompromised, use a treatment duration of 5 days.
1st choice
benzylpenicillin IV 1 million IU 4 times daily

+

ciprofloxacin IV 400 mg 3 times daily

In documented (<1 year) colonisation of the airways with Pseudomonas spp
≥ 18 years

Indications: For (possible) aspiration
Dosage Remarks

Treat as CAP.

Only in massive aspiration can anaerobic coverage be considered: amoxicillin-clavulanic acid IV 1000/200 mg 4 times daily for 3 days

Comments

In case of (suspected) allergy to penicillins and/or cephalosporins:

See protocol: Policy for antibiotic allergy | Radboud UMC

Consult the clinical microbiologist/infectious diseases physician for an alternative regimen.

* clinical stability criteria

  • Temperature < 37.8
  • Pulse < 100
  • Respiratory rate < 24
  • SpO2 > 90 (without mechanical ventilation, without oxygen mask; oxygen delivery via nasal cannula is allowed)
  • Systolic blood pressure > 90
  • No signs of delirium

AMBU-65 score

Treatment depends on the severity of the pneumonia. This is based on the number of AMBU-65 criteria the patient fulfils:

AMBU-65 criteria:

  • Respiratory rate > 30 per minute
  • Mental status: recent disorientation in time, place or person
  • Blood pressure systolic < 90 mmHg and/or diastolic < 60 mmHg
  • Urea > 7 mmol/l
  • Age > 65 years

A Legionella rapid test is performed < 24 hours after admission (during working hours) in case of:

  • risk factors for Legionella (recent travel abroad, during a Legionella outbreak or failure to improve on therapy)

For information on influenza virus (flu): see LWI 4 Pneumonia: (viral) influenza

Adjust antibiotics according to culture results where possible.