Recommendations
| Dosage | Remarks | |
|---|---|---|
|
1st choice
|
cefuroxime IV 1500 mg three times daily for 7 to 10 days
+ ciprofloxacin IV 400 mg three times daily for 7 to 10 days |
AMBU-65 score 4 or 5*: add hydrocortisone 50 mg IV four times daily for 5 days, or shorter with clinical recovery. Not in aspiration or influenza. |
|
if there has been recent (<1 year) colonisation of the airways with ESBL: adjust empirical treatment accordingly. |
| Dosage | Remarks | |
|---|---|---|
|
cefuroxime IV 1500 mg three times daily for 7 to 10 days
+ ciprofloxacin IV 400 mg three times daily for 7 to 10 days |
Only in massive aspiration can anaerobic coverage be considered: add metronidazole 500 mg IV three times daily for 7–10 days. |
In case of (suspected) allergy to penicillins and/or cephalosporins:
See protocol Policy for antibiotic allergy | Radboud UMC
Consult the 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:
Age > 65 years
A pneumococcal urine antigen test must be performed within 12–24 hours; if positive, therapy can be narrowed to IV penicillin or IV amoxicillin.
A Legionella urine antigen test must be performed within 12–24 hours.
*indication for steroids:
Adjust antibiotics according to culture results where possible