Community-acquired pneumonia (CAP): non-severe (CURB65= 0-1)
Community-acquired pneumonia (CAP)
- symptoms consistent with lower respiratory tract infection (i.e. fever, cough, chest pain) AND evidence of consolidation on Chest imaging.
CURB65: Confusion (AMT 8 or less), Urea greater than 7mmol/L, Resp rate 30 breaths per minute or more, BP less than 90mmHg systolic or 60mmHg or less diastolic, Age 65 years or older
- When respiratory viruses are common, then testing for RSV, influenza and SARSCoV2 indicated
- HIV AgAb testing is indicated
- Antibiotics should be given within 4 hours
- See also NICE's guideline on pneumonia in adults: diagnosis and management (NG250)
Treatment duration: 3-5 days
Review empirical treatment within 48 hours
Preferred
amoxicillin 500mg po tds
Alternative
Alternative in pregnancy for patients with penicillin allergy: erythromycin 500 mg po qds
Consider Delabelling of spurious penicillin allergy in patients who are low risk and are clinically stable.
Additional information
Explain to patient that after starting treatment their symptoms should steadily improve, although the rate of improvement will vary with the severity of the pneumonia. Most adults can expect that by:
- 1 week: fever should have resolved
-
4 weeks: chest pain and sputum production should have substantially reduced
-
6 weeks: cough and breathlessness should have substantially reduced
-
3 months: most symptoms should have resolved but fatigue may still be present
-
6 months: they will feel back to normal
Give advice to people with community-acquired pneumonia (or their parents or carers, if appropriate) about:
- Possible adverse effects of the antibiotic(s)
- Seeking further advice (if the person is receiving treatment in the community or via hospital at home service) if:
- symptoms worsen rapidly or significantly or
- symptoms do not start to improve within 3 days or
- the person becomes systemically unwell