antibiotic treatment in community acquired pneumonia (CAP)

Last edited 06/2021 and last reviewed 10/2022

• assess severity in adults based on clinical judgement guided by mortality risk score (CRB65 or CURB65):
  • low severity – CRB65 0 or CURB65 0 or 1
  • moderate severity – CRB65 1 or 2 or CURB65 2
  • high severity – CRB65 3 or 4 or CURB65 3 to 5
  • 1 point for each parameter: confusion, (urea >7 mmol/l), respiratory rate >= 30/min, low systolic (<90 mm Hg) or diastolic (<=60 mm Hg) blood pressure, age >= 65
  • assess severity in children based on clinical judgement
  • offer an antibiotic. Start treatment as soon as possible after diagnosis, within 4 hours (within 1 hour if sepsis suspected and person meets any high risk criteria
    
    
• when choosing an antibiotic, take account of severity, risk of complications, local antimicrobial resistance and surveillance data, recent antibiotic use and microbiological results
• * Stop antibiotics after 5 days unless microbiological results suggest a longer course is needed or the person is not clinically stable

Reference:

• NICE (September 2019).Pneumonia- Diagnosis and management of community- and hospital-acquired pneumonia in adults
• Public Health England (June 2021). Managing common infections: guidance for primary care