Healthcare-associated pneumonia (HAP)
Non-severe healthcare-acquired pneumonia (non-severe signs and not at higher risk of resistance)
Review after 48 hours. Treat for 5 days then review.
Take blood cultures and appropriate samples (e.g. BAL or pleural culture) for culture. Review antibiotic choice when results are available.
Preferred
co-amoxiclav po, see dosing table below:
|
Age |
co-amoxiclav oral dose |
|
1 month to 11 months |
0.5mL/kg of 125mg/31mg/5mL suspension TDS |
|
1 year to 5 years |
10mLs of 125mg/31mg/5mL suspension TDS |
|
6 years to 11 years |
10mLs of 250mg/62mg/5mL suspension TDS |
|
12 years to 17 years |
One 625mg tablet TDS OR 10mLs of 250mg/62mg/5mL suspension TDS if patient cannot take tablets |
Alternative
Other options may be suitable based of microbiology results.
For penicillin allergy (non-severe and severe) OR MRSA positive patients
Under 6 weeks: Discuss with Paediatric ID
6 weeks and over: co-trimoxazole po, see dosing table below
|
Age |
co-trimoxazole oral dose |
|
6 Weeks to 5 Months |
120mg BD |
|
6 Months to 5 Years |
240mg BD |
|
6 Years to 11 years |
480mg BD |
|
12 years to 17 years |
960mg BD |
If iv required and 6 weeks and over: co-trimoxazole 18mg/kg (max 960mg) iv BD
Severe healthcare-acquired pneumonia (severe symptoms or signs of sepsis) or at higher risk of resistance
Other options may be suitable based of microbiology results. Contact Paeds ID for all cases.
Higher risk of resistance includes symptoms or signs starting more than 5 days after hospital admission, relevant comorbidity such as severe lung disease or immunosuppression, recent use of broad-spectrum antibiotics, colonisation with multidrug-resistant bacteria, and recent contact with a health or social care setting before current admission
Preferred
piperacillin-tazobactam 90mg/kg (max 4.5g) iv QDS
Alternative
Other options may be suitable based of microbiology results.
For penicillin allergy (non-severe and severe) OR MRSA positive patients:
6 weeks and over: co-trimoxazole 18mg/kg (max 960mg) iv BD
Under 6 weeks: Discuss with Paediatric ID
If oral is tolerated:
6 weeks and over: co-trimoxazole po, see dosing table below
|
Age |
co-trimoxazole oral dose |
|
6 Weeks to 5 Months |
120mg BD |
|
6 Months to 5 Years |
240mg BD |
|
6 Years to 11 years |
480mg BD |
|
12 years to 17 years |
960mg BD |
Under 6 weeks: Discuss with Paediatric ID