16.2.11
Nosocomial Pneumonias
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 16, Respiratory Conditions.
Clinical Description
Caused by Staphylococcus aureus, gram negative rods (pseudomonas, klebsiella) and Pneumococcus
Fever, cough, shortness of breath, chest pain developing after 48hrs of admission in health facility
Treatment
- Give Amoxicillin + Clavulanic acid 1.2g IV 8 hourly or Ceftriaxone2g IV daily or Ciprofloxacin 400mg 12 hourly IV or Gentamicin240mg IV daily
- Followed by oral Amoxicillin + Clavulanic acid 8 hourlyfor 7 days
If aspiration
- Add Clindamycin 600mg 6 hourly or Metronidazole 400mg 8 hourly or ceftriaxone 2g IV daily for 5-7 days
- Erythromycin 500mg 6 hourly for 7 days
Or
- Give Doxycycline 100mg daily for 7 days
Also think of Pneumocystis jirovecii pneumonia if
- Patient not improving on cap treatment and treat appropriately with high dose
Cotrimoxazole and steroids
- Hypoxic yet clear chest/minimal chest signs
- Immunosuppressed (HIV, malignancy, immunosuppressants)
Check doses against the printed guideline and your clinical judgement before treating a patient. Spotted an error? Report it from the contact links below.
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