Pneumonia: Assessment and Management

Key points

• Assess severity in primary care with CRB65: Confusion (AMTS 8/10 or less), Respiratory rate 30 or more, BP systolic 90 or less and/or diastolic 60 or less, Age 65 or over (1 point each).
• CRB65 0 → home care (mortality under 1%); 1-2 intermediate (1-10%); 3-4 high risk (over 10%) → hospital assessment, particularly a score of 2 or more.
• Point-of-care CRP (if available): under 20 mg/L no antibiotics; 20-100 delayed prescription; over 100 offer antibiotics.
• Hospital uses CURB65 (adds Urea over 7 mmol/L): 0-1 low, 2 moderate, 3-5 high severity.
• Antibiotics (NICE): low severity - amoxicillin (doxycycline/clarithromycin if penicillin-allergic) for 5 days; moderate/high severity - amoxicillin (or co-amoxiclav) plus a macrolide; give within 4 hours of diagnosis and review/de-escalate.

Decision points in this pathway

• Score 0?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.