CURB-65 score

Confusion

Urea >7

Respiratory Rate >30

SBP <90mmHg or

DBP <60mmHg

Age >65

Background

  • Patients who have a CURB-65 score of 3 or more are at high risk of death and should be managed as having severe pneumonia according to the BTS recommendations and require urgent hospital admission.
  • Patients who have a CURB-65 score of 2 are at increased risk of death. They should be considered for short stay inpatient treatment or hospital supervised outpatient treatment. This decision is a matter of clinical judgement.
  • Patients who have a CURB-65 score of 0 or 1 are at low risk of death. They can be treated as having non-severe pneumonia and may be suitable for home treatment.

Algorithm

Community Acquired Pneumonia Management Options
CAP management

Clinical features severe pneumonia

Clinical

Lab

Investigations needed

Resp. rate > 30/min
Diastolic BP < 60mmHg
Underlying disease
Age > 60 years
Multilobar involvement

Urea > 7mmol/L
pO2 < 9kPa
WBC < 4.0
WBC > 20.0

Blood cultures
sputum culture
Clotted blood for viral / atypical serology
Urine for legionella antigen

Treatment and management

Please follow HSE-S antibiotic guidelines


Red flags and pitfalls

Patients suitable for discharge should not have more than one of the following characteristics present (unless they represent the usual baseline status for that patient).

  • Temperature > 37.8° C
  • Heart Rate >100/min
  • Respiratory rate >24/min
  • Systolic BP <90mmHg
  • O2
  • saturation <90%
  • Inability to maintain oral intake and abnormal mental status

A follow up appointment should be arranged (GP to complete) for 6-8 weeks with a CXR to ensure resolution of the consolidation and no underlying malignant process particularly in smokers.

Switching IV to PO

Switch from parenteral drug to the equivalent oral preparation should be made as soon as clinically appropriate.

  • With parenteral cephalosporins, switch to to co- amoxiclav 625 mg tds or moxifloxacin 400 mg mane rather than to oral cephalosporins
  • For those with penicillin allergy consider oral erythromycin or moxifloxacin after discussion with your consultant.