Antimicrobial prescribing: NHS Grampian, Orkney & Shetland
Important: Therapy
No antibiotics required.
Notes:
Provide verbal and written safety netting information*.
*You may be asked to enter a postcode and agree your location to access the relevant information (Cough and Cold, and select appropriate age).
Community acquired pneumonia (CAP)
Warning
What's new / Latest updates
Updated treatment choices dependent on severity, with no antibiotics required if mild.
Link to BSAC pathway for assessment of severity.
Duration now 5 days for moderate to severe.
Treatment in sickle cell disease added.
Micro Organisms
Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Group A streptococcus (GAS)
Atypical pneumonia – Mycoplasma pneumoniae, Chlamydia pneumoniae
Duration
For assessment of severity – please follow BSAC pathway
Mild: No antibiotics required
Moderate - severe: 5 days
In complicated infection/empyema seek advice from paediatric infectious diseases consultant or microbiology.
Important: Therapy
Oral Amoxicillin
Notes:
Provide verbal and written safety netting information*.
IV amoxicillin may be used if the oral route is compromised.
*You may be asked to enter a postcode and agree your location to access the relevant information.
Important: Therapy
Oral Clarithromycin
Notes:
Provide verbal and written safety netting information.*
IV clarithromycin may be used if the oral route is compromised.
*You may be asked to enter a postcode and agree your location to access the relevant information.
Important: Therapy
IV Cefotaxime
+ IV Amoxicillin
Notes:
If no significant clinical response after 48 hours of therapy consider adding oral/IV clarithromycin.
Important: Therapy
Oral/IV Co-amoxiclav
Notes:
If no significant clinical response after 48 hours of therapy consider adding oral/IV clarithromycin.
Important: Therapy
Non-anaphylactic reaction to penicillin:
IV Ceftriaxone* or IV Cefotaxime
* Contraindications to ceftriaxone:
- Concomitant treatment with intravenous calcium (including total parenteral nutrition containing calcium) in premature and full-term neonates
- Full-term neonates with jaundice, hypoalbuminaemia, acidosis, unconjugated hyperbilirubinaemia (bilirubin greater than or equal to 200 umol/L), or impaired bilirubin binding
- 41 weeks or less corrected gestational age
Notes: If ceftriaxone is contra-indicated give IV Cefotaxime.
If no significant clinical response after 48 hours of therapy consider adding oral/IV clarithromycin.
For IV to oral switch seek advice from paediatric infectious diseases consultant or microbiology.
Anaphylactic reaction to penicillin:
Oral/IV Co-trimoxazole#
#Co-trimoxazole is not licensed for use under 6 weeks of age, seek advice from paediatric infectious diseases consultant or at earliest opportunity. If no significant clinical response after 48 hours of therapy consider adding oral/IV clarithromycin.
Notes:
Important: Therapy
IV Ceftriaxone*
+
Oral Clarithromycin
* Contraindications to ceftriaxone
- Concomitant treatment with intravenous calcium (including total parenteral nutrition containing calcium) in premature and full-term neonates
- Full-term neonates with jaundice, hypoalbuminaemia, acidosis, unconjugated hyperbilirubinaemia (bilirubin greater than or equal to 200 umol/L), or impaired bilirubin binding
- 41 weeks or less corrected gestational age
If ceftriaxone is contra-indicated give IV Cefotaxime.
Notes:
Prophylactic phenoxymethylpenicillin can be withheld during treatment of acute infection.
Important: Notes
Follow BSAC Pathway
Viral infection causes approximately 66% of community acquired pneumonias in children (NICE138). Antibiotics are not required for viral infection.
If wheeze is present in a preschool child, primary bacterial pneumonia is unlikely.
Oral therapy should be considered the norm except in patients with complications, severe sepsis or those unable to take oral therapy.
Send samples for viral testing: nasopharyngeal secretions (or throat swabs) in viral transport medium.
Chest x-ray should not be performed routinely in children with uncomplicated acute lower respiratory tract infection.
Take blood cultures and collect sputum samples where possible in severe/complicated pneumonia.
Always consider prior therapy; in patients who have not responded to a recent course of antibiotics consider an alternative agent.
If frequent/recent hospital admissions, underlying structural disease, complex neurodisability patients or atypical clinical course, may require a modified approach – consider discussion with paediatric infectious diseases specialist or microbiology.
If pneumonia occurs following a confirmed influenza infection consider using co-amoxiclav first line, to provide additional staphylococcal cover.