A 65 year old man has been admitted to your Intensive Care Unit with a presumptive diagnosis of community acquired pneumonia. He is sedated, intubated and ventilated, and is haemodynamically stable.

(c) What empiric therapy would you commence (drugs, dosage, route and duration)?  Discuss why.

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College Answer

One example would be: Erythromycin 1 g IV 6 hrly plus ceftriaxone 1 g IV daily. Covers common pathogens including atypicals and Haemophilus (but not pseudomonas, Pneumocystis, Burkholderia), well tolerated, reasonably cheap.

Discussion

Current guidelines recommend a broad-spectrum third generation cephalosprin (eg. ceftriaxone 1g bd) and a macrolide (eg. azithromycin 500mg daily). These should be given IV, for a minimum of 5 days (but more likely for 7)

The most recent NICE guidelines make the following recommendations for the British pneumonia patient with moderate or severe disease:

  • 7-10 days of antibiotics
  • Dual therapy (a β lactam and a macrolide) for severe pneumonia.

References