Community Acquired Pneumonia Treatment in the Community (Adults)

Comments from the Expert Advisory Committee

  • Community acquired pneumonia (CAP) is a pneumonia that is acquired outside hospital.
  • CAP in the community can been defined as:
    • Symptoms of an acute lower respiratory tract illness (cough and at least one other lower respiratory tract symptom)
    • New focal chest signs on examination
    • At least one systemic feature (either a symptom complex of sweating, fevers, shivers, aches and pains and/or temperature of 380C or more)
  • Start antibiotics immediately
  • Review if symptoms are not improving as expected with antibiotics and escalate therapy, or consider hospital referral.
  • Assess severity using the CRB-65 score.

Screenshot 2021-10-08 102909

  • The need for hospital referral should be assessed, and at review, re-assessed using the CRB65 criteria.
  • At convalescence, ensure COVID-19, influenza and pneumococcal vaccinations up to date.

Treatment Table - Community Acquired Pneumonia

Community Acquired Pneumonia (Adults): Antibiotic Treatment Table

Assess using the CRB-65 score (each symptom or sign scores one point)

(Confusion, Respiratory rate ≥ 30/min, BP ≤ 90/60 mmHg, Age ≥ 65)

CRB 65 Score Zero (0) Suitable for home treatment

Review if symptoms are not improving as expected with antibiotics and escalate therapy, or consider hospital referral.
Amoxicillin

500mg every 8 hours

5 days

Avoid in penicillin allergy.

If no response after 48 hours on Amoxicillin monotherapy, consider addition of Clarithromycin or change to Doxycycline
OR Doxycycline 200mg every 24 hours* 5 days

Avoid in pregnancy.

Advise to take with a glass of water and sit upright for 30 minutes after taking.

Can take with food or milk if gastritis is an issue.

Absorption of doxycycline significantly impaired by antacids, iron/calcium/magnesium/zinc-containing products.
OR Clarithromycin (Second line in penicillin allergy) 500mg every 12 hours 5 days Macrolides should be used with caution in pregnancy. Clarithromycin suitable only in 2nd and 3rd trimester in pregnancy. Alternative macrolide for all trimesters of pregnancy: Azithromycin 500mg stat then 250mg every 24 hours from Day 2 to Day 5.

CRB 65 Score 1-2 and assessed suitable for treatment in the community

Review if symptoms are not improving as expected with antibiotics and escalate therapy, or consider hospital referral.

Amoxicillin

PLUS

Clarithromycin

500mg - 1g every 8 hours

500mg every 12 hours
5 days

Avoid amoxicillin in penicillin allergy.

Macrolides should be used with caution in pregnancy. Clarithromycin suitable only in 2nd and 3rd trimester in pregnancy. Alternative macrolide for all trimesters of pregnancy: Azithromycin 500mg stat then 250mg every 24 hours from Day 2 to Day 5.
OR Doxycycline 200mg every 24 hours* 5 days

Avoid in pregnancy.

Advise to take with a glass of water and sit upright for 30 minutes after taking.

Can take with food or milk if gastritis is an issue.

Absorption of doxycycline significantly impaired by antacids, iron/calcium/magnesium/zinc-containing products.
CRB 65 Score 3 or more : urgent hospital admission
Administer Benzylpenicillin prior to transfer 1.2g IV/IM

N/A

Avoid in penicillin allergy

Urgent hospital admission

Seek risk factors for Legionella and Staph.aureus infection

Or

Amoxicillin
1g PO

N/A

* Alternative doxycycline dose: 100mg every 12 hours. 
In non-severe infection, 200mg stat then 100mg every 24 hours can be considered.

  • Pleuritic pain should be relieved using simple analgesia, and consider pulmonary embolism.
  • Consider advising patients on hydration and smoking cessation where appropriate.
  • Consider time off work for patients with CAP dependent on clinical assessment.
  • Advise to consult pharmacist for symptom relief.

Patient Information

Safe Prescribing (visit the safe prescribing page)

Reviewed May 2022