Community Acquired Pneumonia - Adult
NHSL Antimicrobial Guidelines
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)