Nosocomial Pneumonias

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NOSOCOMIAL PNEUMONIAS

CLINICAL DESCRIPTION

Caused by Staphylococcus aureus, gram negative rods (pseudomonas, klebsiella) and Pneumococcus.

SIGNS AND SYMPTOMS

Fever, cough, shortness of breath, chest pain developing after 48hrs of admission in health facility. 

TREATMENT

• Give Amoxicillin + Clavulanic acid 1.2g IV 8 hourly or Ceftriaxone 2g IV daily or Ciprofloxacin 400mg 12 hourly IV or Gentamicin 240mg IV daily
• Followed by oral Amoxicillin + Clavulanic acid 8 hourly For 7 days

If aspiration

• Add Clindamycin 600mg 6 hourly or Metronidazole 400mg 8 hourly or ceftriaxone 2g IV daily for 5-7 days
• Erythromycin 500mg 6 hourly for 7 days

Or 

• Give Doxycycline 100mg daily for 7 days

Also think of Pneumocystis jirovecii pneumonia if

• Patient not improving on cap treatment and treat appropriately with high dose Cotrimoxazole and steroids
• Hypoxic yet clear chest/minimal chest signs
• Immunosuppressed (HIV, malignancy, immunosuppressants)