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Remember to check allergy status

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Paediatric Treatment - Lower Respiratory Tract Infections

Note: Low doses of penicillins are more likely to select out resistance 1, we recommend 500mg of amoxicillin (adults). Do not use quinolone (ciprofloxacin, ofloxacin) first line due to poor pneumococcal activity 2 B-. Reserve all quinolones (including levofloxacin) for proven resistant organisms.

Acute cough, bronchitis

NICE-CKS
NICE 69

Antibiotic little benefit if no co-morbidity 1-4A+
Consider 7d delayed antibiotic with advice 1,5 A
Symptom resolution can take 3 weeks.

Consider immediate antibiotics if older than 80yr and ONE of the following:

-hospitalisation in past year,
-oral steroids,
-diabetic,
-congestive heart failure
OR > 65yrs with 2 of above.

Consider CRP test1A+,4. If CRP <20mg/L no antibiotics, CRP 20-100mg/L delay antibiotics, CRP >100mg/L immediate antibiotics.

Medicine Calendar

amoxicillin

See BNFc

5 days4A+

Community acquired pneumonia (treatment in the community)2,3

BTS 2009
Guideline (PDF)

For adults: Use CRB65 score to guide mortality risk, place of care and antibiotics.1

Each CRB65 parameter scores 1:

Confusion (AMT<8);
Respiratory rate >30/min;
BP systolic <90 or diastolic ≤ 60; Age >65;

  • Score 3-4: urgent hospital admission
  • Score 1-2: hospital assessment or admission
  • Score 0: suitable for home treatment

Always give safety-net advice and likely duration of symptoms. Mycoplasma infection is rare in over 65s1

Medicine Calendar

amoxicillin A+ or
clarithromycin A-

See BNFc

Use 5 days. Review at 3 days & extend to 7-10 days if poor response

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).