Oral therapy for low- to moderate-severity HAP

If oral therapy is indicated for adults and children with low- to moderate-severity HAP (see Approach to managing low- to moderate-severity HAP), use:

amoxicillin+clavulanate 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally or enterally, 12-hourly¹. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate oral dosage adjustment. The usual duration of therapy is 7 days. See advice on patient review and follow-up. amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

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

cefuroxime 500 mg (child 3 months or older: 15 mg/kg up to 500 mg) orally or enterally, 12-hourly³. For dosage adjustment in adults with kidney impairment, see cefuroxime dosage adjustment. The usual duration of therapy is 7 days. See advice on patient review and follow-up. cefuroxime cefuroxime cefuroxime

For adults who have had a severe (immediate or delayed)⁴ hypersensitivity reaction to a penicillin, useNational Institute for Clinical Excellence (NICE). 2019:

1moxifloxacin 400 mg orally or enterally, daily⁵. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. The usual duration of therapy is 7 days. See advice on patient review and follow-up moxifloxacin moxifloxacin moxifloxacin

1trimethoprim+sulfamethoxazole 160+800 mg orally or enterally, 12-hourly. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. The usual duration of therapy is 7 days. See advice on patient review and follow-up. trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole

For children in whom a suitable formulation of cefuroxime is not available, trimethoprim+sulfamethoxazole or moxifloxacin may be suitable alternatives. These can also be used for children who have had a severe (immediate or delayed)⁴ hypersensitivity reaction to a penicillin. Trimethoprim+sulfamethoxazole is preferred because there are fewer data for moxifloxacin in children. Use:

1trimethoprim+sulfamethoxazole (child 1 month or older) 4+20 mg/kg up to 160+800 mg orally or enterally, 12-hourly. The usual duration of therapy is 7 days; see advice on patient review and follow-uptrimethoprim + sulfamethoxazole

2moxifloxacin 10 mg/kg up to 400 mg orally or enterally, daily⁶ ⁷. The usual duration of therapy is 7 days; see advice on patient review and follow-up. moxifloxacin

¹ Amoxicillin+clavulanate may be suitable for children aged 1 month to younger than 2 months but a different dosage is required.Return

² For patients with severe immediate penicillin hypersensitivity who tolerated initial intravenous therapy with ceftriaxone, cefotaxime or cefepime, it is safe to use cefuroxime.Return

³ 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

⁴ 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

⁵ An oral liquid formulation of moxifloxacin is not commercially available; for formulation options for adults 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

⁶ Moxifloxacin 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. Moxifloxacin can be used in children when it is the drug of choice.Return

⁷ An oral liquid formulation of moxifloxacin is not commercially available; for formulation options for children, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return