Intravenous antibiotic therapy for aspiration pneumonia in patients who are not improving on empirical therapy for CAP
To determine whether the below regimens are appropriate for a patient with aspiration pneumonia who has not improved on the empirical regimen for CAP, see Management of aspiration pneumonia in patients who are not improving on empirical therapy for CAP or HAP. If appropriate, add to the empirical regimen for CAP:
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, 12-hourly. See advice on modification and duration of therapy. metronidazole metronidazole metronidazole
Alternatively, if a single-drug regimen is preferred (eg to reduce toxicity or improve adherence), replace the empirical regimen for CAP with:
2+0.2 g formulation
adult, or child 40 kg or more: 2+0.2 g 8-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate intravenous dosage adjustment
OR
1+0.2 g formulation
adult, or child 40 kg or more: 1+0.2 g 6-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate intravenous dosage adjustment
child 1 month to younger than 3 months and less than 4 kg: 25+5 mg/kg 12-hourly
child 1 month to younger than 3 months and 4 kg or more: 25+5 mg/kg 8-hourly
child 3 months or older and less than 40 kg: 25+5 mg/kg up to 1+0.2 g 8-hourly.
For patients with penicillin hypersensitivity, as a single-drug regimen, use:
1clindamycin 600 mg (child: 15 mg/kg up to 600 mg) intravenously, 8-hourly1. See advice on modification and duration of therapy clindamycin clindamycin clindamycin
OR
2moxifloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, daily. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. See advice on modification and duration of therapy2. moxifloxacin moxifloxacin moxifloxacin