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Antibiotics in Community Acquired Pneumonia

POAC supports the Auckland Regional Clinical Pathway (ARCP) for Community Acquired Pneumonia (CAP) which can be found on our website, www.poac.co.nz under clinical guidance, or at http://aucklandregion.healthpathways.org.nz (contact POAC or your PHO for user name and password).

The pathway recommends oral antibiotic therapy rather than IV therapy for the management of CAP in the community. The rationale for this is given on the pathway as follows:

  • Cure of bacterial infections as the result of treatment with amoxycillin (or other penicillins and cephalosporins) is most strongly correlated with the proportion of the treatment duration that the drug concentration is above the level required to kill the bacterium. Cure is poorly correlated with the peak level of amoxicillin.
  • Approximately 90% of strains of Streptococcus pneumoniae causing disease in Auckland are killed by a concentration of 2 mg/L.
  • IV administration of 500mg of amoxicillin rapidly achieves very high peak serum concentrations (approximately 100mg/L), but serum concentrations decline quickly over the next 4 hours.
  • The peak serum concentrations achieved after oral administration of 500mg or 3g of amoxicillin are approximately 10mg/L and 25mg/L respectively. Concentrations of amoxicillin in lung tissue are very similar to the serum concentrations.
  • Amoxycillin 500mg given IV provides a SHORTER period of time in which the serum concentration is above the level required to kill Streptococcus pneumoniae than oral administration of the same dose. There is no advantage from giving the first dose of amoxicillin intravenously.

POAC will only consider funding IV therapy for CAP if it is discussed with and endorsed by a specialist.





 

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