Respiratory Rate >30
SBP <90mmHg or
- 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.
Clinical features severe pneumonia
Resp. rate > 30/min
Urea > 7mmol/L
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
- 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.