GGC Medicines


Adult Therapeutics Handbook

Lower respiratory tract infections

Lower respiratory tract infections

Chronic obstructive pulmonary disease (COPD)

Also see management of Acute exacerbation of COPD.

Pneumonia

Obtain respiratory samples for microbiology (sputum) and virology (throat gargle) and consider influenza during peak season. If clinical suspicion of influenza, please refer to Health Protection Scotland Influenza guidelines for latest treatment options.

For further information on assessment / monitoring and general management, see Pneumonia guideline

CURB-65 Calculation (for CAP)

Clinical judgement is essential when deciding on the management of all patients with CAP and calculating a CURB-65 score does not replace this. Each patient must be managed individually and the interpretation of the CURB-65 score is best refined through clinical judgement that takes into account all the clinical information available at the time. For example: a young patient with a respiratory rate of >40 breaths/minute may warrant hospital supervised management despite a CURB-65 score of 1. Clinical judgement is especially important in patients at high risk of death (CURB-65 scores 3, 4 and 5) in whom decisions regarding intravenous administration of antibiotics or transfer to critical care facilities need to be made.

N.B. CURB-65 should not be used to assess the severity of conditions other than pneumonia.

Calculating CURB-65 score
  • New Confusion (Abbreviated Mental Test score < 8 - see table below);
  • Urea >7mmol/L;
  • Respiratory Rate ≥30 breaths/minute;
  • BP - systolic <90 mmHg or, diastolic ≤60 mmHg;
  • age ≥65 years

Score 1 point for each feature present.

Adapted by permission from BMJ Publishing Group Limited. Thorax, W S Lim, M M van der Eerden, R Laing, W G Boersma, N Karalus, G I Town, S A Lewis, J T Macfarlane, 58: 377 - 382, © 2015 BMJ Publishing Group Ltd.
 

The Abbreviated Mental Test

A score of 8 or less has been used to define mental confusion in the CURB-65 severity score. Each question scores 1 mark - total 10 marks.

1. Age 6. Recognition of two persons (doctor, nurse, etc.)
2. Date of birth 7. Recall address (e.g. 42 West Street)
3. Time (to nearest hour) 8. Date of First World War
4. Year 9. Name of present Monarch
5. Name of hospital 10. Count backwards (20-1)
H M Hodkinson. Evaluation of a mental test score for assessment of mental impairment in the elderly, Age Ageing (1972) 1(4): 233-238, by permission of Oxford University Press.
 

Community acquired Pneumonia (CAP)

Hospital acquired pneumonia (HAP)

Pneumonia - Other

 

Content last updated August 2019