Recommended therapy of most likely microbiologically defined causes of pneumonia complicating influenza (local specialist advice should always be sought)
| Pathogen | Preferred | Alternative |
|---|---|---|
| S pneumoniae | amoxicillin 500 mg–1.0 g tds PO or benzylpenicillin 1.2 g qds IV | cefuroxine 0.75–1.5 g tds IV or cefotaxime 1–2 g tds IV or ceftriaxone 2 g od IV or erythromycin 500 mg qds PO or clarithromycin 500 mg bd PO |
| S aureus | Non-MRSA: flucloxacillin 1–2 g qds IV ± rifampicin 600 mg od or bd, PO/IV | Consult local microbiologist for further advice |
| MRSA: vancomycin 1 g bd IV (dose monitoring) ± rifampicin 600 mg od or bd PO/IV | ||
| H influenzae | Non-β-lactamase-producing: amoxicillin 500 mg tds PO or ampicillin 500 mg qds IV | cefuroxime 750 mg–1.5 g tds IV or cefotaxime 1–2 g tds IV or ceftriaxone 2 g od IV |
| β-lactamase-producing: co-amoxiclav 625 mg tds PO or 1.2 g tds IV | or fluoroquinolone PO or IV | |
| Gram negative enteric bacilli | cefuroxime 1.5 g tds IV or cefotaxime 1–2 g tds IV or ceftriaxone 1–2 g bd IV | fluoroquinolone IV or imipenem 500 mg qds IV or other carbapenems, eg meropenem, ertapenem |
| P aeruginosa | ceftazidime 2 g tds IV ± gentamicin or tobramycin (dose monitoring) | either ciprofloxacin 400 mg bd IV or piperacillin 4 g tds IV ± gentamicin or tobramycin (dose monitoring) |