Community Acquired Pneumonia (CAP)

NHSL Antimicrobial Guidelines
NHS Lanarkshire

Duration

(IV/Oral): 5 days

 

 

CURB65 Score
Score 1  for  each  of:

  • Confusion new (AMT ≤ 8/10)
  • Urea > 7mmol/L
  • RR ≥ 30/min
  • BP SBP < 90mmHg or DBP ≤ 60mmHg   
  • Age ≥ 65

Additional Adverse Prognostic features:

  • SpO2 <92% or PaO2 < 8kPa on any FIO2
  • Multi-lobar change on CXR

CURB 65 score may overestimate CAP severity in the elderly therefore correlate sepsis criteria.

Non-Severe CAP (CURB65 Score ≤ 2)

Therapy

CURB65 Score6≤ 2

Oral Amoxicillin 500mg - 1g 8 hourly

Penicillin Allergy or Alternative Required
Oral Doxycycline2, 9 200mg stat then 100mg daily

Notes:

Total duration: 5 days

Severe CAP (CURB65 score: 3-5 or SEPSIS)

Therapy

CURB65 score6: 3-5 or SEPSIS

IV Amoxicillin 1g 8 hourly
OR
If previously treated or adverse prognostic features: IV Co-amoxiclav10 1.2g 8 hourly.

 

Stepping down to:
Oral Amoxicillin 1g 8 hourly
OR
Co–amoxiclav 625mg 8 hourly (if previously treated or adverse prognostic features).

 

Penicillin Allergy
Oral Levofloxacin1, 2, 8, 9, 10, 12 500mg 12 hourly.

Notes:

Total Duration (IV/Oral): 5 days

Notes

Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.

Drug Specific Cautions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
  3. Gentamicin/Vancomycin refer to online calculators.
  4. ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
  5. Monitor sodium.
  6. See CURB65 definition.
  7. Reference: The Renal Drug Handbook. Online access.
  8. See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
  9. Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
  10. Caution in renal impairment – see BNF or pharmacy for advice.
  11. Use with caution may increase K+ and decrease renal function. Monitor.
  12. High / Excellent oral bioavailability, IV route available for NBM or vomiting.
  13. See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.

Editorial Information

Last reviewed: 01/12/2022

Next review date: 01/12/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: NHS Lanarkshire Antimicrobial Management Committee

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: March 2023