Adult
Community-acquired pneumonia (CAP): moderate/ severe (CURB65=2-5)
Community-acquired pneumonia (CAP)
- symptoms consistent with lower respiratory tract infection (i.e. fever, cough, chest pain) AND evidence of consolidation on Chest X-ray.
CURB65: Confusion (AMT 8 or less), Urea greater than 7, Resp rate 30 or more, BP less than 90 systolic or 60 or less diastolic, Age 65 years or older
- Take blood cultures and appropriate samples (e.g. pus, pleural fluid) for culture
- Consider further investigation for atypical pneumonia including urine for Legionella antigen
- When community respiratory viruses are common, SarsCoV2, RSV and/or influenza testing is indicated
- HIV AgAb testing is indicated
- See also NICE NG138 (revised 2022) and NICE NG191 (revised 2023)
Treat for 3-5 days (review iv daily)
Review empirical treatment within 48 hours
Preferred
amoxicillin 1g iv tds or 500mg po tds (oral dose can be increased to 1g po tds in particularly severe cases where the patient is able to tolerate that dose)
+ doxycycline 100mg po bd
Alternative
For non-severe and severe penicillin allergy: clarithromycin 500mg bd po or iv if unable to take po
Alternative in pregnancy for patients with penicillin allergy: erythromycin 500 mg qds po or iv
Consider Delabelling of spurious penicillin allergy in patients who are low risk and are clinically stable.