Guidelines
Community Acquired Pneumonia (CAP)

Community Acquired Pneumonia (CAP)

Severity Score

Pneumonia Severity Index Calculator

  • Clinical prediction tool in addition to clinical judgment in determining need for hospitalization of the patients with CAP
  • PSI is more complicated than CRB-65 calculator but better predictor of mortality
  • Patients with PSI ≤90 are candidates for Outpatient therapy

CURB-65 Score of Pneumonia Severity Calculator

CURB-65 Points:

  • 0 Points
    • Risk Group: Low
    • %30 day Mortality: 0.6%
    • Location: Outpatient
  • 1 Point
    • Risk Group: Low
    • %30 day Mortality: 2.7%
    • Location: Outpatient
  • 2 Points
    • Risk Group: Moderate
    • %30 day Mortality: 6.8%
    • Location: Consider inpatient or outpatient with close follow up
  • 3 Points
    • Risk Group: Severe
    • %30 day Mortality: 14%
    • Location: Inpatient with possible ICU admission
  • 4 & 5 Points
    • Risk Group: Highest
    • %30 day Mortality: 27.8%
    • Location: Inpatient with possible ICU admission

Pathogens

Legionella pneumophila

Treatment options:

  • Moxifloxacin 400 mg PO/IV q24h
  • LevoFLOXacin 750 mg PO/IV q24h
  • Azithromycin 500 mg PO/IV q24h
  • Doxycycline 100 mg PO q12h
  • Trimethoprim/Sulfamethoxazole 1 DS tab PO q12h

Duration of treatment is 7-10 days. Consider extending treatment duration to 14-21 days if lacking clinical response and/or patient is immunocompromised.

Outpatient Antimicrobial Regimens

  • PSI ≤90
  • CURB-65 Score 0-1 and may consider outpatient with 2 points with close follow up
  • No risk factors for MRSA/multidrug-resistant organisms
  • Chronic heart, lung liver, or renal disease

  • Diabetes mellitus

  • Alcoholism

  • Malignancy

  • Asplenia

Inpatient Antimicrobial Regimens

Risk factors include:

  • Prior isolation of MRSA or P. aeruginosa
  • Hospitalization AND treatment with parenteral antibiotics within prior 90 days
     

Risk factors for MRSA include:

  • Pneumonia in IVDU
  • Pneumonia associated influenza

More Information

  • Metlay, J., Waterer, G., Long, A., Anzueto, A., Brozek, J., Crothers, K., Cooley, L., Dean, N., Fine, M., Flanders, S., Griffin, M., Metersky, M., Musher, D., Restrepo, M., Whitney, C. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. IDSA/ATS treatment guidelines: Am J Repir Crit Care Med 2019; 200:e45-e67.

  • Sanfords Guide App. Pneumonia, Community acquired, Adult, In-patient and Out-patient. Last update August 4, 2020. Accessed June 3, 2021.