BTS guidelines for the management of community-acquired pneumonia in adults. Thorax 2009;64 (Suppl III):III 1-55 Updated guideline on the management of CAP – includes diagnosis, severity assessment, microbiological profile and therapeutic management in both the community and hospital. Assessing severity using CRB65 scores in addition to clinical judgement allows patients to be stratified according to increasing risk of mortality. (score 0, mortality risk 1.2%; score 1. 5.3%; score 2. 12.2%; scores 3-4, up to 33%).Patients with a CRB65 score ≥1 are deemed to have moderately severe CAP and should be assessed with a view to hospital admission. Patients with moderately severe CAP should receive antibiotics which also cover atypical organisms. BTS guidelines states that for patients treated at home 7 days is appropriate. With moderate to severe pneumonia 7 – 10 days should be considered based on severity and response.
Loeb M. Community-acquired pneumonia. In: Clinical Evidence. London BMJ Publishing Group. 2008;07:1503-1516. Accessed 06.01.2010. RATIONALE: While there is no direct information about the benefits of antibiotics in the treatment of CAP in the community, there is consensus they are beneficial. No one regime has shown superiority over another.
van der Poll T, Opal S. Pathogenesis, treatment and prevention of pneumococcal pneumonia. Lancet. 2009; 374: 1543-1556. RATIONALE: Detailed review of pneumococcal pneumonia, the most common cause of CAP. Includes discussion of clinical features, risk factors and rationale for high dose penicillins to overcome resistance.
Cals JWL. Marjolein JC. Schot Sanne AM. et al. Point-of-Care C-Reactive Protein Testing and Antibiotic Prescribing for Respiratory Tract Infections: A Randomized Controlled Trial. Ann Fam Med 2010; 8:124-33. RATIONALE: This, and related articles by the same authors, indicate that the use of point of care CRP tests in general practice can assist diagnosis resulting in improved patient satisfaction as well as reduced overall antibiotic use due to reduced use of unnecessary antibiotics. An economic evaluation (Cals et al, J Eval Clin Pract 2011 Dec 17(6): 1059-69) showed that the use of CRP tests as well as communication skills training are cost effective interventions to reduce antibiotic prescribing for LRTI.