Community Acquired Pneumonia: Treatment Guidelines

Question 1

What route of administration should be used for outpatient adults?

Answer 1

PO

Question 2

What antibiotic should be given for outpatient adults, <65 years old, no antibiotics within 90 days and no comorbidities?

Answer 2

Amoxicillin

Question 3

What antibiotic should be given for outpatient adults, >65 years old, antibiotics within 90 days or comorbidity?

Answer 3

Amoxicillin-clavulanate
OR
Cefuroxime

Question 4

What alternative antibiotic can be used for outpatient adults?

Answer 4

Moxifloxacin
OR
Levofloxacin

Question 5

What route of administration should be used for inpatient (non-severe) adults?

Answer 5

PO / IV

Question 6

What antibiotic should be given for inpatient adults (non-severe), <65 years old, no antibiotics within 90 days and no comorbidities?

Answer 6

Ampicillin

Question 7

What antibiotic should be given for inpatient adults (non-severe), >65 years old, antibiotics within 90 days or comorbidity?

Answer 7

Amoxicillin-Clavulanate 
OR 
Cefuroxime 
OR 
Ceftriaxone

Question 8

What alternative antibiotic can be used for inpatient (non-severe) adults?

Answer 8

Moxifloxacin
OR
Levofloxacin

Question 9

What route of administration should be used for inpatient (severe) adults?

Answer 9

IV

Question 10

What antibiotic should be given for inpatient adults (severe), <65 years old, no antibiotics within 90 days and no comorbidities?

Answer 10

Amoxicillin-clavulanate 
OR
Cefuroxime 
OR 
Ceftriaxone 
PLUS 
Macrolide / Azalide

Question 11

What antibiotic should be given for inpatient adults (severe), >65 years old, antibiotics within 90 days or comorbidity?

Answer 11

Amoxicillin-clavulanate 
OR
Cefuroxime 
OR 
Ceftriaxone 
PLUS 
Macrolide / Azalide

Question 12

What alternative antibiotic can be used for inpatient (severe) adults?

Answer 12

Moxifloxacin
OR
Levofloxacin

Question 13

What antibiotic should be used for ambulant paeds 0-2 months old?

Answer 13

N/A

Recommend hospitalization for all children less than 2 months of age

Question 14

What antibiotic should be used for hospitalized paeds 0-2 months old?

Answer 14

1. Ampicillin / penicillin IV + Aminoglycoside
   OR
2. Ceftriaxone / Cefotaxime IV

Question 15

What antibiotic should be used for ambulant paeds 3 months - 5 years old?

Answer 15

1. Amoxicillin PO

Question 16

What antibiotic should be used for hospitalized paeds 3 months - 5 years old?

Answer 16

1. Ampicillin IV / Amoxicillin PO 
OR 
2. Cefuroxime IV / Amoxicillin-clavulanate 
OR 
3. Cefotaxime / Ceftriaxone IV

Question 17

What antibiotic should be added for hospitalized paeds 3 months - 5 years old if S. Aureus is suspected?

Answer 17

Cloxacillin

Question 18

What antibiotic should be used for ambulant paeds 5 years and older?

Answer 18

1. Amoxicillin PO

2. Macrolide PO if suspect Mycoplasma Pneumoniae or Chlamydophilia spp

Question 19

What antibiotic should be used for hospitalized paeds 5 years and older?

Answer 19

1. Ampicillin IV / Amoxicillin PO 
OR 
2. Cefuroxime IV / Amoxicillin-clavulanate 
OR 
3. Cefotaxime / Ceftriaxone IV

Question 20

What antibiotic should be added for hospitalized paeds 5 years and older if S. Aureus is suspected?

Answer 20

Cloxacillin

Question 21

What antibiotic should be added for hospitalized paeds 5 years and older if M. Pneumoniae or Chlamydophilia spp is suspected?

Answer 21

Macrolide

Question 22

How is the diagnosis of CAP made?

Answer 22

1. Fever AND/OR
2. Breathlessness AND/OR
3. Tachycardia AND/OR
4. New focal chest signs

Question 23

The decision to hospitalize is based on any of the following:

Answer 23

1. CRB-65 >1
2. Elderly
3. Comorbidity
4. Cyanosis
5. Complications e.g. pleural effusion
6. Poor SES

Question 24

If patient is not hospitalized, what should be done?

Answer 24

TREATMENT!

1. Young, no comorbid illness: High-dose amoxicillin
2. Alternative in settings of low macrolide resistance for severe beta-lactam allergy: Macrolide / Azalide
3. Elderly >65 years and / or comorbid illness: Amoxicillin-Clavulanate or 2nd generation cephalosporin

Question 25

If patient is hospitalized, what should be done?

Answer 25

Additional investigations as indicated: - sputum, gram stain & culture - blood culture - thoracentesis for pleural effusion - Xpert MTB / RIF - Haematology and biochemistry

Question 26

Severe CAP is determined based on what?

Answer 26

1. Clinical assessment | 2. CURB-65 >2

Question 27

If severe CAP is determined, what treatment should be given?

Answer 27

Amoxicillin/clavulanate OR 2nd or 3rd generation cephalosporin AND Macrolide/azalide

Question 28

If no severe CAP, what should be considered next?

Answer 28

Age >65 years? | Comorbidity?

Question 29

If patient is >65 years and / or has a comorbidity (no severe CAP) what treatment should be given?

Answer 29

Amoxicillin/clavulanate OR 2nd or 3rd generation cephalosporin +/- Macrolide/azalide

Question 30

If patient is <65 years and has no comorbidity (no severe CAP) what treatment should be given?

Answer 30

Amoxicillin / Ampicillin