Community acquired Pneumonia
For influenza-related pneumonia click here
CURB-65 is a BTS recommended severity rating for community acquired pneumonia (CAP) and should not be confused with the ABC criteria defined in the flow diagram. Patients with a CURB-65 score of 3 or more are at highest risk of death and should be managed as having severe pneumonia. Patients with a score of 2 are at increased risk of death and should be considered for short stay inpatient treatment or hospital supervised outpatient treatment. Patients with a score of 0 or 1 are at low risk of death and can be treated as having non-severe pneumonia possibly suitable for home treatment.
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CURB -65 Severity rating score for CAP-One point for each below
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Initial
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Description
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C
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Mental Confusion
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U
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Blood Urea > 7 mmol/l
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R
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Respiratory Rate ≥ 30/min
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B
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Low Blood Pressure (Diastolic ≤ 60mmHg or Systolic <90mmHg)
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65
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Age ≥ 65 years
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Severity
(classification)
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1st line oral/iv antibiotics
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Anaphylactic penicillin allergy
(see explanatory notes)
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A
Minor to moderate infection
CURB-65 = 0 to 1
Review doses in renal impairment
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AMOXICILLIN 500mg po tds
OR
if atypicals suspected use:
DOXYCYCLINE 200mg po od as monotherapy
For influenza-related pneumonia click here
Treatment duration: 5 - 7 days
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DOXYCYCLINE 200mg po od as monotherapy
If contra-indicated discuss with specialist PHYSICIAN or MICROBIOLOGIST
For influenza-related pneumonia click here
Treatment duration: 5 - 7 days
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B
Moderate to severe infection
CURB-65 = 2
Review doses in renal impairment
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AMOXICILLIN 1g po tds
plus
CLARITHROMYCIN 500mg po bd
Treatment duration: 5 - 7 days
For influenza-related pneumonia click here
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CLARITHROMYCIN 500mg po bd as monotherapy
IF POOR CLINICAL RESPONSE DISCUSS WITH specialist PHYSICIAN or MICROBIOLOGIST
Treatment duration: 5 - 7 days
For influenza-related pneumonia click here
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C
Severe life threatening infection
CURB-65 ≥ 3
Review doses in renal impairment
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For influenza-related pneumonia click here
- Send urine sample to microbiology for pneumococcal/legionella antigen tests
BENZYLPENICILLIN 2.4g iv qds
plus
CLARITHROMYCIN 500mg bd iv/po
plus
GENTAMICIN 5mg/kg iv stat dose
(nb: use 3mg/kg if >65 years old)
If serum creatinine 150-300 micromol/L use:
GENTAMICIN 80-120mg IV stat
GENTAMICIN THERAPY TO BE REVIEWED AFTER FIRST 24HRS. Continue only if evidence of gram –ve sepsis. Check level 12-18hrs after first dose. Continue according to local protocol if required.
OR
If gentamicin is contra-indicated (see GHNHSFT protocol)
OR
If definite history of rash allergy but no anaphylactic penicillin allergy (see explanatory notes) use:
MEROPENEM 1g iv tds
plus
CLARITHROMYCIN 500mg bd iv/po
If suspected/confirmed MRSA add:
TEICOPLANIN 400mg iv every 12 hours for 3 doses then 600mg iv once daily and review with microbiologist
Maintain treatment pending pre-dose (trough) level on Day 5
Mild to moderate infection (10-20mg/l)
Severe(>20mg/l,<60mg/l)
Re-assay after 6 to 8 days
If laboratory evidence of pneumococci use:
BENZYLPENICILLIN 2.4g iv qds as monotherapy.
If aspiration pneumonia suspected use:
TAZOCIN 4.5g iv tds
If definite history of rash allergy but no anaphylactic penicillin allergy (see explanatory notes) use:
MEROPENEM 1g iv tds
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For influenza-related pneumonia click here
- Send urine sample to microbiology for pneumococcal/legionella antigen tests
Discuss with specialist PHYSICIAN or MICROBIOLOGIST
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IV to Oral Switch
(explanatory notes)
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As in SCHEDULE B unless lab results indicate otherwise. Treatment duration should be a minimum of 7 days. Patients with severe pneumonia that is microbiologically undefined should be treated for 7-10 days. This should be extended to 14-21 days where legionella, staphylococcal or Gram negative pneumonia are suspected or confirmed.
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For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)