Intravenous therapy for low- to moderate-severity HAP

If intravenous therapy is indicated for adults and children with low- to moderate-severity HAP (see Approach to managing low- to moderate-severity HAP), useAckerman, 2020Gijsen, 2021Hartman, 2021National Institute for Clinical Excellence (NICE), 2019:

1ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) intravenously, daily. See advice on patient review, intravenous to oral switch and follow-up. The usual total duration of therapy (intravenous + oral) is 7 days ceftriaxone ceftriaxone ceftriaxone

OR

1cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment. See advice on patient review, intravenous to oral switch and follow-up. The usual total duration of therapy (intravenous + oral) is 7 days cefotaxime cefotaxime cefotaxime

OR

2amoxicillin+clavulanate intravenously. See advice on patient review, intravenous to oral switch and follow-up. The usual total duration of therapy (intravenous + oral) is 7 days amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

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 younger than 3 months and less than 4 kg: 25+5 mg/kg 12-hourly

child 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 adults and children who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use ceftriaxone or cefotaxime (see dosages above).

For adults and children who have had a severe immediate1 hypersensitivity reaction to a penicillin, ceftriaxone or cefotaxime (at the dosages above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For adults who have had a severe immediate1 hypersensitivity reaction to a penicillin in whom ceftriaxone or cefotaxime is not used, or for adults who have had a severe delayed2 hypersensitivity reaction to a penicillin, use:

1moxifloxacin 400 mg intravenously, daily. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. See advice on patient review, intravenous to oral switch and follow-up. The usual total duration of therapy (intravenous + oral) is 7 days moxifloxacin moxifloxacin moxifloxacin

OR

1trimethoprim+sulfamethoxazole 160+800 mg intravenously, 12-hourly. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. See advice on patient review, intravenous to oral switch and follow-up. The usual total duration of therapy (intravenous + oral) is 7 days. trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole

Because there are fewer data for moxifloxacin in children, trimethoprim+sulfamethoxazole is preferred for children who have had a severe immediate1 hypersensitivity reaction to a penicillin in whom ceftriaxone or cefotaxime is not used, or for children who have had a severe delayed2 hypersensitivity reaction to a penicillin; use:

1trimethoprim+sulfamethoxazole (child 1 month or older) 4+20 mg/kg up to 160+800 mg intravenously, 12-hourly. See advice on patient review, intravenous to oral switch and follow-up. The usual total duration of therapy (intravenous + oral) is 7 daystrimethoprim + sulfamethoxazole

OR

2moxifloxacin 10 mg/kg up to 400 mg intravenously, daily3. See advice on patient review, intravenous to oral switch and follow-up. The usual total duration of therapy (intravenous + oral) is 7 days.moxifloxacin

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 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