Community Acquired Pneumonia - Treatment in the Community

Community acquired pneumonia-treatment in the community

BTS 2009

NICE 191

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 less than or equal to 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 CRB65=0: Amoxicillin

500mg TDS

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

Penicillin allergy:

Clarithromycin

500mg BD 

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

or Doxycycline

200mg stat then 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

Penicillin allergy:

Doxycycline alone

200mg stat then 100mg OD

 7-10 days