A diagnosis of bronchopneumonia with any of the following features is considered serious and warrants consideration for HDU/ITU:

Respiratory rate > 30/min

Diastolic blood pressure 60 mmHg

New confusion

Plasma urea > 7 mmol/L

Hypoxia (PaO2 < 8kPa)

Treatment - non-severe

Amoxycillin 500mg TDS PO (or erythromycin 500mg QDS if penicillin allergy)

The combination of both drugs may be appropriate in some cases

Treatment - severe

TAKE arterial blood gas sample

GIVE high concentration oxygen

CONSIDER requirement for ventilation

Community acquired infection

If organism unknown START clarithromycin 500mg BD IV over 1 hr

If neutropaenic START gentamicin 2.5mg/kg BD IV and Tazocin 4.5g QDS IV
     (and consider metronidazole IV if bowel symptoms)

Hospital acquired infection

START cefotaxime 1g TDS IV

Discuss with consultant micro-biologist regarding most appropriate continuing

Treatment - continuing

IV antibiotic requirement reviewed daily; total therapy 7-14 days

Adapted from Frimley Park Hospital guidelines

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