Continuing treatment

Antibiotics should be adjusted according to sensitivities once available. Failure to respond to treatment in 72h should prompt consideration of infections more common in the immunocompromised or other diagnoses.

Hospital-acquired pneumonia requires treatment with appropriate antibiotics for 24h after symptoms subside (usually 3-5 days). After this period cultures should be repeated (off antibiotics if there has been improvement). Some ICUs will use longer courses — a recent multicentre study showed no difference in outcome between 8 and 15 days' treatment.

In atypical or pneumococcal pneumonia, 10-14 days of antibiotic treatment is usual (though no evidence base exists to indicate the optimal duration of therapy).

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