Pneumonia Community
Summary
CURB-65 score
Confusion
Urea >7
Respiratory Rate >30
SBP <90mmHg or
DBP <60mmHg
Age >65
- Patients who have a CURB-65 score of 3 or more are at high risk of death and should be managed as having severe pneumonia according to the BTS recommendations and require urgent hospital admission.
- Patients who have a CURB-65 score of 2 are at increased risk of death. They should be considered for short stay inpatient treatment or hospital supervised outpatient treatment. This decision is a matter of clinical judgement.
- Patients who have a CURB-65 score of 0 or 1 are at low risk of death. They can be treated as having non-severe pneumonia and may be suitable for home treatment.
Algorithm
Clinical features severe pneumonia
Clinical |
Lab |
Investigations needed |
|
Resp. rate > 30/min |
Urea > 7mmol/L |
Blood cultures |
Treatment and management
Please follow HSE-S antibiotic guidelines
Switch from parenteral drug to the equivalent oral preparation should be made as soon as clinically appropriate.
- With parenteral cephalosporins, switch to to co- amoxiclav 625 mg tds or moxifloxacin 400 mg mane rather than to oral cephalosporins
- For those with penicillin allergy consider oral erythromycin or moxifloxacin after discussion with your consultant.
Red flags and pitfalls
- Patients suitable for discharge should not have more than one of the following characteristics present (unless they represent the usual baseline status for that patient).
- Temperature > 37.80 C
- Heart Rate >100/min
- Respiratory rate >24/min
- Systolic BP <90mmHg
- O2 saturation <90%
- Inability to maintain oral intake and abnormal mental status
- A follow up appointment should be arranged (GP to complete) for 6-8 weeks with a CXR to ensure resolution of the consolidation and no underlying malignant process particularly in smokers.
