NICE has issued new draft guidance on antimicrobial prescribing for hospital-acquired pneumonia.
For non-severe community-acquired pneumonia in adults, first-choice antibiotic is co-amoxiclav 500/125 mg orally 3 times daily (t.i.d) or 1.2 g t.i.d intravenous (IV) for 5 days, followed by review. Levofloxacin 200 mg 1-2 times daily orally or IV, can be used.
For severe symptoms, IV piperacillin with tazobactam 4.5 g t.i.d is recommended or levofloxacin 500 mg 1-2 times daily, ceftazidime 2 g t.i.d, ceftriaxone 2 g once daily or cefuroxime 750 mg 3-4 times/day. Meropenem 0.5-1 mg t.i.d and ceftazidime with avibactam 2/0.5 g t.i.d are recommended only on specialist advice.
For pneumonia with suspected or confirmed methicillin-resistant Staphylococcus aureus in either adults or children, recommended treatment is vacomycin. Linezolid can be used if vacomycin can be used, but only on specialist advice.
Oral antibiotics that are advised for use after IV therapy are co-amoxiclav 500/125 mg t.i.d., levofloxacin 500 mg 1-2 daily or cefuroxime 500 mg twice daily, all for a total of 5 days, including days on IV treatment.
For children aged 3 months and over with non-severe infection, the recommended first-line antibiotic is co-amoxiclav but clarithromycin can be used as an alternative.
For severe infection, IV piperacillin with tazobactam, ceftazidime, ceftriaxone or cefuroxime are recommended (doses available here).
In children, recommended step-down oral treatment after IV therapy is co-amoxiclav, clarithromycin and cefuroxime.
The complete draft guidance is available here.
Feedback on the guidelines is invited before 11 March 2019 at 5 pm. The final version of the guidelines is expected to be published in July.
Separate guidance has been issued on prescribing for community-acquired pneumonia.