We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.
You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.
To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Please get in touch with ann.wales3@nhs.scot with any questions.
Severity assessment
CURB65 score is calculated by giving 1 point for each of the following prognostic features:
Required investigations
Antibiotic Recommendation
Recommended total duration: 5 days
| Recommended Antibiotic | Amoxicillin 500mg every 8 hours orally |
| Penicillin allergy | Doxycycline 200mg on first day, then 100mg daily for 4 days orally |
Required investigations
Antibiotic recommendation
Recommended total duration: 5 days (total duration = IV + oral)
| Recommended Antibiotic |
Amoxicillin 500mg - 1g every 8 hours orally If oral route unavailable: Amoxicillin 1g every 8 hours IV If atypical pathogens suspected see atypical pneumonias |
| Penicillin allergy |
Doxycycline 200mg on first day and then 100mg daily orally If oral route unavailable: Clarithromycin 500mg every 12 hours IV (risk of phlebitis) |
See separate guidance for severe pneumonia in the frail elderly to avoid harms of 4C antibiotics.
Required investigations
Antibiotic Recommendation
Recommended total duration: 5 days (total duration = IV + oral)
| Recommended Antibiotic |
Co-amoxiclav 1.2g every 8 hours IV PLUS Clarithromycin 500mg every 12 hours orally (IV only if oral route unavailable). Risk of phlebitis with IV Clarithromycin. Oral formulation has excellent pulmonary tissue penetration and is as effective as IV for chest infections. |
| Penicillin allergy |
Vancomycin (use NHS Lothian Calculator located on AMT intranet page, choose trough levels 10-15 mg/L) PLUS Ciprofloxacin 500mg every 12 hours orally (if oral route unavailable: 400mg every 12 hours IV) Avoid fluoroquinolones if taking steroids and the elderly. Review MHRA Quinolone Warning before prescribing. |
DO NOT ADD CLARITHROMYCIN IF CIPROFLOXACIN USED AS BOTH COVER ATYPICALS (SEE SECTION BELOW), AS DOES DOXYCYCLINE.
| IV-to-ORAL switch |
Co-amoxiclav 625mg every 8 hours orally Consider need for ongoing atypical pneumonia cover see atypical pneumonia section below. |
| Penicillin allergy | Doxycycline 200mg on first day and then 100mg daily orally |
Notes
Stop antibiotic treatment after 5 days unless
In all patients consider:
This guidance avoids the use of co-amoxiclav and ciprofloxacin in frail elderly patients to reduce the risk of C.diff infection.
Severity: CURB65 3-5
Required investigations
Consider HIV testing in line with national recommendations.
Antibiotic Recommendation
Total duration: 5 days (total duration = IV + oral)
| Recommended Antibiotic |
Amoxicillin 1g every 8 hours IV PLUS Gentamicin IV (use NHS Lothian Calculator located on AMT intranet page) |
| Penicillin allergy |
Vancomycin IV (use NHS Lothian Calculator located on AMT intranet page) PLUS Gentamicin IV (use NHS Lothian Calculator located on AMT intranet page) |
IV-to-ORAL switch
| IV-to-Oral switch Recommended Antibiotic | Amoxicillin 1g every 8 hours orally |
| Penicillin allergy | Doxycycline 200mg on first day and then 100mg daily orally |
Clarithromycin, Doxycycline, Ciprofloxacin all cover atypical pneumonia organisms.
STOP Clarithromycin at 72 hours if atypical pathogen investigations are negative.
Atypical pneumonia risk factors Include:
Clinical features:
Investigations only recommended in high severity CAP or where there is a high suspicion of atypical pneumonia. Required investigations for atypical pneumonias.
Consider HIV testing in line with national recommendations.
Notes
Atypical organisms:
Antimicrobial prescribing: NHS Lothian