Oral antibiotic regimens for CAP in residents of an aged-care facility

For CAP in residents of an aged-care facility who are treated in the facility, if oral or enteral empirical antibiotic therapy is appropriate, use:

amoxicillin 1 g orally or enterally1, 8-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment. See advice on patient review and duration of therapy. amoxicillin

For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin2, use:

1doxycycline 100 mg orally or enterally1, 12-hourly3; see advice on patient review and duration of therapy doxycycline

OR

2cefuroxime 500 mg orally or enterally1, 12-hourly. For dosage adjustment in adults with kidney impairment, see cefuroxime dosage adjustment. See advice on patient review and duration of therapy4. cefuroxime

For patients who have had a severe (immediate or delayed)5 hypersensitivity reaction to a penicillin, seek expert advice.

Atypical pathogens6 (eg Legionella species) are uncommon causes of CAP in residents of an aged-care facility, but may be suspected based on epidemiology, clinical history7 or risk exposuresFukuyama, 2013Kang, 2017Ma, 2013. If an atypical pathogen is suspected, add doxycycline to amoxicillin or cefuroxime at the dosages above, while awaiting results of microbiological tests. If Legionella pneumonia is confirmed, see Legionella pneumonia in adults.

1 For information on modifying oral dose forms for residents with difficulty swallowing or enteral feeding tubes, consult the product information, a drug formulary, a pharmacist, a medicines information service or Don’t Rush to Crush (which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus).Return
2 For residents with severe immediate penicillin hypersensitivity who tolerated ceftriaxone, it is safe to use cefuroxime.Return
3 Doxycycline can cause oesophagitis, which is more likely in bed-bound residents. Ensure doxycycline is taken with food and a full glass of water, and that the resident remains upright after the dose.Return
4 Cefuroxime is preferred to cefalexin or cefaclor because of its superior antipneumococcal activity; see Practical information on using beta lactams: cephalosporins for further information.Return
5 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return
6 There is no universally accepted definition of atypical pathogens. The term is used to describe bacteria that are intrinsically resistant to beta lactams and not identifiable by standard blood or sputum culturesGarin, 2022.Return
7 Risk factors for Legionella disease (Legionnaires disease) include chronic lung disease, smoking, diabetes, advanced kidney disease, cancer, and immune compromise (including chronic corticosteroid use).Return