Preferred and alternative initial empirical antibiotic treatment regimens and parenteral to oral switch regimens for pneumonic and non-pneumonic lower respiratory tract infections complicating influenza managed in hospital
| Preferred | Alternative* |
|---|---|
| *An alternative regimen is provided for those intolerant of or hypersensitive to preferred regimen. | |
| †Clarithromycin may be substituted for those with gastrointestinal intolerance to oral erythromycin and also has the benefit of twice daily dosage and better cover against H influenzae. | |
| ‡Levofloxacin and moxifloxacin are the only currently UK licensed fluoroquinolones with enhanced activity against S pneumonia, in addition to cover for S aureus. Levofloxacin comes in an oral and parenteral formulation and is licensed for severe pneumonia. Moxifloxacin comes in an oral formulation only in the UK and is not licensed for severe pneumonia. In the future, other fluoroquinolones such as gemifloxacin and gatifloxacin are likely to extend this choice, when licensed in the UK. | |
| Switch from parenteral drug to the equivalent oral preparation should be made as soon as clinically appropriate, in the absence of microbiologically confirmed infection. In the case of the parenteral cephalosporins, the oral switch to co-amoxiclav 625 mg tds is recommended rather than to oral cephalosporins. | |
| od, once daily; bd, twice; tds, 3 times; qds, 4 times: IV, intravenous; PO, oral. | |
| (1) Hospital-treated, non-pneumonic bronchial complications (including exacerbations of COPD and acute bronchitis) requiring antibiotic therapy | |
| co-amoxiclav 625 mg tds PO, or doxycycline 200 mg stat and 100 mg od PO | Macrolide (erythromycin 500 mg qds PO or clarithromycin 500 mg bd† PO) or fluoroquinolone with enhanced pneumococcal activity, eg levofloxacin 500 mg od PO or moxifloxacin 400 mg od PO‡ |
| (2) Hospital-treated, non-severe pneumonia | |
| co-amoxiclav 625 mg tds PO or doxycycline 200 mg stat and 100 mg od PO | Macrolide (erythromycin 500 mg qds PO or clarithromycin 500 mg bd† PO) or Fluoroquinolone with enhanced pneumococcal activity, eg levofloxacin 500 mg od PO or moxifloxacin 400 mg od PO‡ |
| or if IV needed: | |
| co-amoxiclav 1.2 g tds IV or cefuroxime 1.5 g tds IV or cefotaxime 1 g tds IV | Macrolide (erythromycin 500 mg qds IV or clarithromycin 500 mg bd† IV) or levofloxacin 500 mg od IV‡ |
| (3) Hospital-treated, severe pneumonia | |
| co-amoxiclav 1.2 g tds IV or cefuroxime 1.5 g tds IV or cefotaxime 1 g tds IV plus Macrolide (erythromycin 500 mg qds IV or clarithromycin 500 mg bd† IV) | Fluoroquinolone with some enhanced pneumococcal activity, eg levofloxacin 500 mg bd IV, PO‡ plus, either Macrolide (erythromycin 500 mg qds IV or clarithromycin 500 mg bd† IV) or Beta-lactamase stable antibiotic (co-amoxiclav 1.2 g tds IV or cefuroxime 1.5 g tds IV or cefotaxime 1 g tds IV) |