Recommendations
| Dosage | Remarks | |
|---|---|---|
|
1st choice
|
cefuroxime IV 1500 mg tds for 5 days
|
AMBU-65 score 4 or 5**: add hydrocortisone 50 mg IV four times daily for 5 days, or shorter with clinical recovery. Not for aspiration or influenza.
- If the patient has not clinically improved and does not meet clinical stability criteria* on day 5, extend total antibiotic duration to 7 days - If the patient is immunocompromised, then treatment duration 7 days - Consider Pseudomonas coverage in patients colonised with Pseudomonas spp |
|
1st choice
|
benzylpenicillin IV 1 million IU four times daily
+ ciprofloxacin IV 400 mg three times daily |
In case of documented (<1 year) airway colonisation with Pseudomonas spp |
|
If there is recent (<1 year) airway colonisation with ESBL: adjust empirical management accordingly. |
| Dosage | Remarks | |
|---|---|---|
|
Treat as CAP. Only in massive aspiration may anaerobic coverage be considered: amoxicillin-clavulanic acid IV 1000/200 mg four times daily for 3 days.
|
In case of (suspected) allergy to penicillins and/or cephalosporins:
See protocol: Management of antibiotic allergy | Radboud UMC
Consult the medical microbiologist/infectious diseases physician for an alternative regimen.
Other remarks:
Treatment depends on the severity of the pneumonia. This is based on the number of criteria of the AMBU-65 score that the patient meets:
AMBU-65 score:
A pneumococcal urinary antigen test must be performed within 12-24 hours; if positive, therapy can be narrowed to penicillin IV or amoxicillin IV.
A Legionella urinary antigen test must be performed within 12-24 hours.
For information about influenza virus (flu): see LWI 4 Pneumonia: (viral) influenza
**indication for steroids:
Adjust antibiotics where possible based on culture results.
* clinical stability criteria
No signs of delirium