Empirical Antimicrobial Therapy Prescribing Guidance for Adults - NHS Grampian

L. R. T. I.
CAP HAP
CURB65: Confusion (new), Early (≤4 days of
Urea >7, RR>30, DBP<60 admission) Treat as
or SBP<90, >65yo for CAP
Others: spo2<92% or Late (>5 day)
multilobar consolidation or
cavitation on CXR Non-severe x5/7
1st: PO Amox 1g 8*
Low CURB: 0-1 x5/7 2nd: PO Doxy
PO Amoxicillin 1g 8* or PO 100mg 12* or PO
Doxycycline 200mg stat Co-trimoxazole
then 100mg OD. 960mg 12*

Mod CURB: 2 x5-7 days Severe x7-10 days

1st: PO/IV Amoxicillin 1g 8* 1st: IV Co-amox
+ PO Clarithromycin 500mg 1.2g 8* + IV
12* (until atypical excluded) Gentamicin if life
2nd: PO Doxycycline threatening IVOST
100mg 12* or if IV required, Co-amoxiclav 625mg
treat as CURB>3 8*.
2nd: IV/PO
High CURB: ≥3 x7-10days Levofloxacin 500mg
No Previous Abx IV If MRSA likely +
Amoxicillin 1g 8* + PO Vancomycin IV
Clarithromycin 500mg 12*
(until atypical excluded)
IVOST Doxycycline eoCOPD
monotherapy 100mg 12* or Abx if purulent
Amoxicillin 1g 8* + sputum +  WCC or
Clarithromycin 500mg 12* CRP.
(until atypical excluded)
Mild to Mod x5/7
Previous Abx 1st: IV Co- 1st: PO Amox 1g 8*
amoxiclav 1.2g 8* + PO/IV 2nd: Doxy 200mg
Clarithromycin 500mg 12* stat then 100mg OD.
(until atypical excluded)
Switch to PO Doxycycline Severe x7/7
monotherapy 100mg 12* 1st: Co-trimox
2nd: Co-trimoxazole 960mg 960mg IV 12* IVOST
12* IV or Levofloxacin same 12* or Doxy
500mg 12* IVOST PO 200mg stat then
Doxycycline monotherapy 100mg 12*
100mg 12* or Co- 2nd: Clarith 500mg
trimoxazole 960mg 12* 12* IV IVOST

Aspiration Pneumonia x7/7

1st PO: PO Amoxicillin 1g 8* + PO Metro 400mg 8*

1st IV: IV Amoxicillin 1g 8* + IV Metro 500mg 8*

2nd: PO/IV Clarith 500mg 12*+ Metro 8* (PO 400mg or

IV 500mg)