Empirical therapy for complicated parapneumonic effusion or empyema complicating low- to moderate-severity CAP in adults

For antibiotic management of complicated parapneumonic effusion or empyema complicating low- to moderate-severity CAP in adults, use:

1amoxicillin+clavulanate 2+0.2 g intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate intravenous dosage adjustment. See advice on modification and duration of therapy amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

OR

1amoxicillin+clavulanate 1+0.2 g intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate intravenous dosage adjustment. See advice on modification and duration of therapy. amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

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

ceftriaxone 2 g intravenously, daily; see advice on modification and duration of therapy ceftriaxone ceftriaxone ceftriaxone

PLUS

metronidazole 500 mg intravenously, 12-hourly; see advice on modification and duration of therapy. metronidazole metronidazole metronidazole

For adults who have had a severe immediate1 hypersensitivity reaction to a penicillin, ceftriaxone plus metronidazole (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 is not used, or a severe delayed2 hypersensitivity reaction to a penicillin, use:

moxifloxacin 400 mg intravenously, daily. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. See advice on modification and duration of therapy. moxifloxacin moxifloxacin 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