P11 Establishing the dose and empirical efficacy of benzylpenicillin for the treatment of severe community-acquired pneumonia
Abstract
Abstract Background In cases of community acquired pneumonia (CAP), Streptococcus pneumoniae is the commonest causative pathogen and benzylpenicillin should be considered the most appropriate empirical treatment.1 Objectives To determine: (i) what dose of benzylpenicillin is safe in the empirical treatment of CAP, including pneumococcal pneumonia and (ii) the impact of transitioning empirical CAP treatment guidelines (for CURB-65 ≥3) from co-amoxiclav to benzylpenicillin. The dose of benzylpenicillin required to adequately treat >90% of pneumococcal isolates from blood culture was used to assess the former. Whilst the 30 and 90 day mortality was assessed 3 months pre- and post-transition to benzylpenicillin, for the latter. Methods All cases of bloodstream infection (BSI) caused by S. pneumoniae were identified via the laboratory information management system. MIC determination by diffusion gradient strip testing (Etest) method were included. The MIC for all S. pneumoniae isolates were determined to establish the range and percentage for which benzylpenicillin at 1.2 g IV q6h would be an effective treatment. Mortality data was reviewed pre- and post-implementation of empirical CAP guideline change (November 2024) from co-amoxiclav and doxycycline to benzylpenicillin (1.2 g IV q6h) and doxycycline. The 30 and 90 day all-cause mortality for all patients with a coded first diagnosis of ‘lobar pneumonia’ and ‘pneumococcal pneumonia’ was assessed from December 2023–February 2024…
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