Community Acquired Pneumonia - Treatment in the Community

Use CRB65 score to guide mortality risk, place of care & antibiotics.

Each CRB65 parameter scores 1: Confusion (AMT8); Respiratory rate ≥30/min; BP systolic <90 or diastolic ≤60; Age 65; 

Score 3 urgent hospital admission (give immediate IM benzylpenicillin or oral amoxicillin 1g, or in penicillin allergy oral doxycycline 200mg / oral co-trimoxazole 960mg if delayed admission / life-threatening) ;

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.

Also treat as severe if multilobar consolidation or cavitation on chest X-ray

Mycoplasma infection is rare in >65s. 

Consider immune deficiency and testing for HIV.

Refer to BTS Guidelines for further information:

IF CRB65=0amoxicillin

500mg three times daily

 

CRB65=0: use 5 days. If no response in 48 hours consider admission.

or erythromycin

500mg three times daily

CRB65=0: use 5 days. If no response in 48 hours, consider admission.

or doxycycline (not suitable for those under 12 years.)

200mg stat then100mg once daily

CRB65=0: use 5 days. If no response in 48 hours consider admission.

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

amoxicillin

500mg three times daily

 7-10 days

AND erythromycin

500mg four times daily

 7-10 days

or doxycycline alone

200mg stat then 100mg once daily

 7-10 days