Adult
Healthcare-associated pneumonia (HAP) including aspiration pneumonia: non severe
For frail patients: Refer to LRTI + functional decline
If patient develops signs and symptoms within 48 hours of hospital admission: See Community acquired pneumonia guidelines
- Healthcare: Hospital, community hospital, nursing home.
- Aspiration pneumonia does NOT require antimicrobial treatment unless there is clear evidence of secondary bacterial infection.
- Patients who have tracheostomy or are intubated can have respiratory sampling performed.
- Legionella antigen testing on urine can be considered.
- SARSCoV2 Resp PCR indicated
- When community respiratory viruses are common RSV and/or influenza testing is indicated
- Modify treatment according to sensitivity test results.
- Antibiotics should be given within 4 hours
- See also NICE's guideline on pneumonia in adults: diagnosis and management (NG250).
Treat for 3-5 days
Review empirical treatment within 48 hours
Preferred
amoxicillin 500mg po tds
Alternative
For penicillin allergy non-severe:
- doxycycline 100mg po bd, or,
- cefalexin 1g po tds (can be increased to 1.5g po tds-qds), or,
- co-trimoxazole 960mg po bd
For penicillin allergy severe:
- doxycycline 100mg po bd, or,
- co-trimoxazole 960mg po bd
For patients with penicillin allergy label consider penicillin allergy assessment and delabelling
Additional information
- Seek specialist advice from a microbiologist for people with hospital-acquired pneumonia if they have:
- symptoms that are not improving as expected with antibiotics or
- multidrug-resistant bacteria
- Explain to patient that after starting treatment their symptoms should steadily improve, although the rate of improvement will vary with the severity of the pneumonia. Most adults can expect that by:
- 1 week: fever should have resolved
- 4 weeks: chest pain and sputum production should have substantially reduced
- 6 weeks: cough and breathlessness should have substantially reduced
- 3 months: most symptoms should have resolved but fatigue may still be present
- 6 months: they will feel back to normal