Community Acquired Pneumonia - Treatment in the Community

Community acquired pneumonia-treatment in the community

BTS 2009

NICE 191

Start antibiotics immediately

Use CRB65 score to guide mortality risk, place of care & antibiotics 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 intermediate risk consider hospital assessment; Score 0 low risk: consider home based care.

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

If no reponse to antibiotics after 2 weeks  consider possibility of lung cancer or tuberculosis and arrange chest X-ray. Seek risk factors for Staph aureus and Legionella.

IF CRB65=0amoxicillin

500mg TDS

 

CRB65=0: use 5 days. Review at 3 days & extend to 7-10 days if poor response.

or clarithromycin

500mg BD 

CRB65=0: use 5 days. Review at 3 days & extend to 7-10 days if poor response.

or doxycycline

200mg stat/100mg OD 

CRB65=0: use 5 days. Review at 3 days & extend to 7-10 days if poor response.

If CRB65=1,2 & AT HOME, clinically assess need for dual therapy for atypicals:

amoxicillin

500mg TDS 

 7-10 days

AND clarithromycin

500mg BD 

 7-10 days

or doxycycline alone

200mg stat/100mg OD

 7-10 days