HOSPITAL ACQUIRED PNEUMONIA

Question 1

Symptoms of HAP

Answer 1

• Cough
• Breathing
• Fever
• Feeling unwell
• Shivering
• Chest pain
• Loss of appetite

Question 2

Causes of HAP

Answer 2

• P.aeruginosa
• S.aureus
• MSSA
• MRSA

Question 3

Doxycycline in children

Answer 3

• NOTE: no doxy in children – discolouration of teeth. Teeth deposit. Bone deposit
• Avoid tetracyclines in age 12 and under

Question 4

How soon should treatment be commenced after diagnosis?

Answer 4

within 4 hours of
(within 1 hour if the patient has suspected sepsis and meets any of the high risk criteria)

Question 5

Treatment of HAP

Answer 5

1. FIRST: Co-Amoxiclav
2. SECOND (adults): Doxycycline, or Cefalexin (pen allergy) or Co-trimoxazole [unlicensed], or Levofloxacin [unlicensed]
   SECOND (children): Clarithromycin

Question 6

Severe symptoms or at higher risk of resistance

Answer 6

Piperacillin with tazobactam
Ceftazidime
Ceftriaxone
Cefuroxime

IV FIRST LINE:
- Piperacillin with tazobactam
- ceftazidime
- ceftazidime with avibactam, - ceftriaxone
- cefuroxime
- levofloxacin [unlicensed]
- or meropenem.

Question 7

If meticillin-resistant Staphylococcus aureus confirmed or suspected

Answer 7

add vancomycin, or teicoplanin, or linezolid (under specialist advice only if vancomycin cannot be used).