Modification of therapy for nonmultidrug-resistant Enterobacterales pneumonia

For adults and children with nonmultidrug-resistant Enterobacterales pneumonia, modify therapy based on the results of susceptibility testing.

Consider a switch from intravenous to oral therapy once the patient improves. For guidance on when to switch to oral therapy, see Guidance for intravenous to oral switch. For adults and children with nonmultidrug-resistant Enterobacterales pneumonia, if the pathogen is susceptible and pneumonia is not high-severity1 or necrotising, use:

1amoxicillin+clavulanate 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally or enterally, 12-hourly2. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate oral dosage adjustment. See advice on duration of therapy amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

OR

1trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally or enterally, 12-hourly. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. See advice on duration of therapy trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole

OR

2ciprofloxacin 500 mg (child: 12.5 mg/kg up to 500 mg) orally or enterally, 12-hourly34. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. See advice on duration of therapy. ciprofloxacin ciprofloxacin ciprofloxacin

For intravenous to oral switch in adults and children with nonmultidrug-resistant Enterobacterales pneumonia who have high-severity1 or necrotising pneumonia, use ciprofloxacin if the isolate is susceptible:

ciprofloxacin 500 mg (child: 12.5 mg/kg up to 500 mg) orally or enterally, 12-hourly34. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. See advice on duration of therapy.ciprofloxacinciprofloxacin ciprofloxacin

For management of patients who are not improving, see (as relevant):

1 Assessment of pneumonia severity is included for community-acquired pneumonia (CAP) in adults and children 2 months or older, and hospital-acquired pneumonia (HAP) in adults and children.Return
2 Amoxicillin+clavulanate may be suitable for children aged 1 month to younger than 2 months but a different dosage is required.Return
3 An oral liquid formulation of ciprofloxacin is not commercially available; for formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return
4 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