Pneumonia may be classified as Community Acquired (present on admission to hospital or developing within 48 hours of admission) or Hospital Acquired (developing at least 48 hours after admission or within 10 days of discharge). Pneumonia is defined as features of respiratory infection (cough, purulent sputum, fever, pleurisy, with new focal abnormalities on respiratory examination or CXR).
The CURB-65 score predicts 30 day mortality and is a useful tool to support decisions regarding admission and management of community acquired pneumonia (see page below for flow diagram and the guidance for pneumonia in the infection section for CURB-65 criteria). It should be used in conjunction with SIRS criteria (see Infection management guidelines ) and should aid clinical judgement, not replace it. It is not used for aspiration pneumonia or infective exacerbations of asthma / COPD.
Community acquired pneumonia (CAP) studies show increased mortality in young patients when antibiotic treatment is delayed. Prescribe antibiotic for immediate administration. The flow diagram further below outlines the general management of CAP; calculate CURB-65 score first (see pneumonia guidance in infection section) before prescribing.
|Hospital acquired||See infection section for treatment options (search for HAP)|
|Suspected Staphylococcus aureus pneumonia (e.g. IVDA, post influenzae or chicken pox)||See infection section (search for pneumonia)|
|Aspiration pneumonia||See infection section (search for aspiration pneumonia)|
|Legionella pneumonia||If confirmed, discuss with microbiology to guide antibiotic choice. If severe consider extending treatment up to 14-21 days|
|Cavitating pneumonia of any type||Discuss with local Respiratory Team early on. Consider Staphlyococcus, Streptococcus, tuberculosis, Gram-negative (e.g. Klebsiella) and non-infectious causes (lung cancer,vasculitis).|
For oral step down - see IVOST guideline
NIV / CPAP should not be used for respiratory failure in pneumonia outside of an ITU setting as delayed transition to invasive ventilation (if required) increases mortality. If ITU admission is not appropriate due to comorbidities then NIV / CPAP on the ward could be considered as ceiling of treatment.
See here to calculate CURB-65 score.
Note: Serious drug interactions with certain antibiotics, see infection section. Further information can be found in Appendix 1 of BNF