Adult
Healthcare-associated pneumonia (HAP) including aspiration pneumonia: severe
If sepsis is suspected see Systemic sepsis of UNKNOWN source
If patient develops signs and symptoms within 48 hours of hospital admission: See Community acquired pneumonia guidelines
- Healthcare: Hospital, community hospital, nursing home.
- For more complex cases where escalation of treatment is considered, please discuss with Micro/ID.
- Patients who have tracheostomy or are intubated can have respiratory sampling performed.
- Legionella antigen testing on urine can be considered.
- Modify treatment according to sensitivity test results.
- Antibiotics should be given within 4 hours.
Treat for 3-5 days (review iv daily)
Review empirical treatment within 48 hours
Preferred
Including penicillin allergy non-severe: cefazolin 2g iv tds
For MRSA positive patients: ADD linezolid 600mg po bd (iv if NBM) (See linezolid drug monograph for information about monitoring required)
If unable to have linezolid: substitute linezolid with teicoplanin iv
Alternative
Penicillin allergy severe (including if MRSA positive): co-trimoxazole 960mg po or iv 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