Severe CAP (CURB 65 score ≥3 or any CURB65 score WITH features of sepsis/critically ill)

Important: Therapy

Co-amoxiclav 1.2g IV 8 hourly 

AND

Clarithromycin 500mg PO/IV 12 hourly

 

If there is a previous history of MRSA - add Linezolid 600mg PO 12 hourly

 

Notes:

Important: Therapy

Levofloxacin 500mg PO 12 hourly (consider safety issues)

If there is a previous history of MRSA - add Linezolid 600mg PO 12 hourly

Notes:

Levofloxacin is highly bioavailable so IV should only be used if oral route is compromised and/or concerns with GI absorption.

If levofloxacin is not preferable  e.g. seizure history, QT prolongation:

IV Vancomycin AND IV Gentamicin AND PO Clarithromycin 500mg PO 12 hourly