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

Recommendations

≥ 18 years
	Дозування	Ремарки
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
	Дозування	Ремарки
		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

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

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:

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.