HAP
| Criterion |
Marker |
| C |
Confusion (abbreviated mental test score <= 8/10) |
| U |
urea > 7 mmol/L |
| R |
Respiration rate >= 30/min |
| B |
Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg |
| 65 |
Aged >= 65 years |
NICE recommend, in conjunction with clinical judgement:
- consider home-based care for patients with a CURB65 score of 0 or 1 - low risk (less than 3% mortality risk)
- consider hospital-based care for patients with a CURB65 score of 2 or more - intermediate risk (3-15% mortality risk)
- consider intensive care assessment for patients with a CURB65 score of 3 or more - high risk (more than 15% mortality risk)
Investigations
- chest x-ray
- in intermediate or high-risk patients NICE recommend blood and sputum cultures, pneumococcal and legionella urinary antigen tests
- CRP monitoring is recommend for admitted patients to help determine response to treatment
Management of low-severity community acquired pneumonia
- amoxicillin is first-line
- if penicillin allergic then use a macrolide or tetracycline
- NICE now recommend a 5 day course of antibiotics for patients with low severity community acquired pneumonia
Management of moderate and high-severity community acquired pneumonia
- dual antibiotic therapy is recommended with amoxicillin and a macrolide
- a 7-10 day course is recommended
- NICE recommend considering a beta-lactamase stable penicillin such as co-amoxiclav, ceftriaxone or piperacillin with tazobactam and a macrolide in high-severity community acquired pneumonia
Discharge criteria and advice post-discharge
NICE recommend that patients are not routinely discharged if in the past 24 hours they have had 2 or more of the following findings: