Community Acquired Pneumonia - Treatment in the Community

NICE Clinical Knowledge Summaries - Community Acquired Pneumonia 

Start antibiotics immediately

Use CRB65 score to guide mortality risk, place of care & antibiotics

Each CRB65 parameter scores 1: Confusion (AMT<8); Respiratory rate >30/min; BP systolic <90 or diastolic ≤60; Age >65;

Low severity (score 0) - consider home based care

Moderate severity - (score 1 - 2) - intermediate risk consider hospital assessment 

High severity (score 3 - 4) - consider urgent hospital admission

Always give safety-net advice and likely duration of symptoms. Mycoplasma infection is rare in >65s.

If no response to antibiotics after 2 weeks consider possibility of lung cancer or tuberculosis and arrange chest X-ray. Seek risk factors for Staph aureus and Legionella (e.g. older age, smoker, underlying immunosuppression).

HIV testing is recommended as CAP is an HIV indicator condition.