Intravenous therapy for nonmultidrug-resistant Enterobacterales pneumonia

The following treatment recommendations apply to pneumonia caused by Klebsiella pneumoniae and Escherichia coli isolates that are nonmultidrug-resistant (non-MDR). For management of pneumonia caused by other Enterobacterales, or multidrug-resistant isolates of K. pneumoniae or E. coli, see Multidrug-resistant Enterobacterales pneumonia.

For the treatment of adults and children with pneumonia caused by nonmultidrug-resistant K. pneumoniae and E. coli isolates, use:

1ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) intravenously, daily. For patients with septic shock or requiring intensive care support, use ceftriaxone 1 g (child 1 month or older: 50 mg/kg up to 1 g) intravenously, 12-hourly. See advice on modification and duration of therapy ceftriaxone ceftriaxone ceftriaxone

1cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly. For patients with septic shock or requiring intensive care support, use cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment. See advice on modification and duration of therapy. cefotaxime cefotaxime cefotaxime

For patients who have had a nonsevere (immediate or delayed) or a severe immediate¹ hypersensitivity reaction to a penicillin, use ceftriaxone or cefotaxime as above.

For patients who have had a severe delayed² hypersensitivity reaction to a penicillin, use:

ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, 12-hourly. For patients with obesity, with septic shock or requiring intensive care support, use ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, 8-hourly³. For dosage adjustment in adults with kidney impairment, see ciprofloxacin intravenous dosage adjustment. See advice on modification and duration of therapy. ciprofloxacin ciprofloxacin ciprofloxacin

Pharmacokinetics may be altered in patients who are critically ill (eg because of enhanced kidney clearance or changes in volume of distribution). To ensure adequate drug exposure in patients with pneumonia caused by nonmultidrug-resistant K. pneumoniae and E. coli isolates who have septic shock or require intensive care support, modified dosages of ceftriaxone, cefotaxime and ciprofloxacin are recommended. Once the critical illness has resolved, consider switching to the standard dosage. If the isolate is not reported to have dose-dependent susceptibility to these drugs (ie susceptible dose dependent [SDD] or susceptible increased exposure [I or SIE]), it may also be appropriate to switch to the standard dose – seek expert advice.

¹ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

² 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

³ Ciprofloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Ciprofloxacin can be used in children when it is the drug of choice.Return