Community Acquired Pneumonia - Adult

Warning

In adults, 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.

Score 0: low risk, consider home based care.

Score 1-2: intermediate risk, consider hospital assessment.

Score 3-4: urgent hospital admission

 

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

Drug details

Drug

IF CRB65=0:

First choice:

Amoxicillin

Dosage

500mg

Duration

3 times a day 5 days

Drug

Penicillin allergy or alternative required:

Clarithromycin

Dosage

500mg

Duration

twice daily 5 days

Drug

OR

Doxycycline

Dosage

200mg

100mg

Duration

on day 1 then

once daily for 4 further days (not in under 12’s)

Drug

OR (penicillin allergy in pregnancy)

Erythromycin

Dosage

500mg

Duration

4 times a day 5 days

Drug

IF CRB65=1 OR 2:

Clinically assess need for dual therapy for atypicals (such as legionella or mycoplasma, mycoplasma uncommon in over 65s)

Amoxicillin

Dosage

500mg

Duration

3 times a day 5 days

Drug

AND

Clarithromycin

Dosage

500mg

Duration

twice daily for 5 days

Drug

OR (in pregnancy)

Erythromycin

Dosage

500mg

Duration

4 times a day 5 days

Drug

Penicillin allergy:

Use Doxycycline alone

Dosage

200mg

100mg

Duration

on day 1 then

once daily for 4 further days (not in under 12’s)

Editorial Information

Last reviewed: 18/05/2022

Next review date: 18/05/2025

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

Version: V1

Approved By: AMC; ADTC

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

Document Id: June 2022