Community Acquired Pneumonia - Treatment in the Community
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 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:
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.
or doxycycline alone
200mg stat then 100mg once daily