-Fever/chills, cough, tachypnea.
-CURB-65 / PSI to determine site/setting of treatment discussed.
-Antibiotic choices discussed.
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Tools for evaluation of pneumonia severity include:
- SMART-COP – Predicts the likelihood of the need for invasive ventilation or vasopressor support,
- SMART-COP – Predicts the risk of 30-day mortality and the need for admission to the intensive-care unit, and
- CURB-65 or CRB-65.
In an outpatient setting, CURB-65 and CRB-65 are easy to use. However, they have weaker predictive values for 30-day mortality.
“In patients with community-acquired pneumonia, it is necessary to decide on both the antibiotic regimen and the treatment setting. The decision regarding site of care is based on the severity of illness, which can be assessed with tools such as the CURB-65 score, which take into account factors such as respiratory rate, blood pressure, uremia, confusion, and age. Patients who have only mild symptoms can be treated with azithromycin on an outpatient basis if there is a low level of macrolide resistance in the community. If there is a high level of resistance in the community, if the patient has comorbidities such as diabetes mellitus or COPD, or if there is a history of use of an immunosuppressing drug or recent use of an antibiotic, the patient can still be treated as an outpatient but should be treated with levofloxacin.
Patients with more severe symptoms, such as an elevated pulse rate or respiratory rate, should be treated on an inpatient basis with ceftriaxone or azithromycin. Patients who have more severe symptoms along with bronchiectasis should be treated with piperacillin/tazobactam plus levofloxacin.
Patients with the most severe symptoms, including hypotension, a more elevated pulse rate, low oxygen saturation, and confusion, should be treated in the intensive-care unit with levofloxacin and vancomycin.” ABFM
References / Further Reading
IDSA Guidelines
Am Fam Physician 2016;94(9):698-706. Community-acquired pneumonia in adults: Diagnosis and management.